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NOTE: A surveillance case definition is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. Surveillance case definitions are not intended to be used by healthcare providers for making a clinical diagnosis or determining how to meet an individual patient’s health needs.

Clinical Description

An inflammatory illness that occurs as a delayed sequela of group A streptococcal infection

Major criteria: carditis, polyarthritis, chorea, subcutaneous nodules, and erythema marginatum

Minor criteria: a) previous rheumatic fever or rheumatic heart disease; b) arthralgia; c) fever; d) elevated erythrocyte sedimentation rate, positive C-reactive protein, or leukocytosis; and e) prolonged PR interval on an electrocardiogram

Laboratory Criteria For Diagnosis

No specific laboratory test exists for the diagnosis of rheumatic fever

Case Classification


An illness characterized by a) two major criteria or one major and two minor criteria (as described in Clinical Description) and b) supporting evidence of preceding group A streptococcal infection.1


Supporting evidence to confirm streptococcal infection includes increased antistreptolysin-O or other streptococcal antibodies, throat culture positive for group A streptococcus, or recent scarlet fever. The absence of supporting evidence of preceding streptococcal infection should make the diagnosis doubtful, except in Sydenham chorea or low-grade carditis when rheumatic fever is first discovered after a long latent period from the antecedent infection.

The 1997 case definition appearing on this page was previously published in the 1990 MMWR Recommendations and Reports titled Case Definitions for Public Health Surveillance.2 Thus, the 1990 and 1997 versions of the case definition are identical.


  1. American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984;69:204A-8A.
  2. CDC. (1990). Case Definitions for Public Health Surveillance. MMWR, 39(RR-13), 1-43.