Rates of acute rheumatic fever (ARF) have remained stable in many developing countries, despite a dramatic decline in the incidence of ARF in industrialised countries in the 20th century.1 Globally, it is estimated that more than 330 000 cases of ARF occur each year in children aged 5–14 years and that over 95% of these cases are found in less developed countries.1 Although there are ample data to support the claim that ARF has virtually disappeared from industrialised nations, there are fewer data from low- and middle-income nations.1,2

The most comprehensive recent descriptions of the clinical manifestations of ARF come from outbreaks in the United States and from the Australian Indigenous population in the Northern Territory; there are few descriptions of the clinical profile of ARF in
less developed nations.3,4 Likewise, there are few descriptions of the clinical presentation of rheumatic heart disease (RHD) in developing countries.5 We therefore designed a study to characterise the clinical epidemiology of patients admitted to hospital with
ARF and RHD in Fiji. This study was part of a series of studies designed to estimate the burden of group A streptococcal disease in Fiji and to prepare for potential clinical trials of group A streptococcal vaccines.