Under investigation - A case that has been notified but information is not yet available to classify it as suspect, probable or confirmed.

Suspect -
Initial attack requires all of the following:

• strong clinical suspicion of ARF
• insufficient signs and symptoms to fulfil diagnosis of confirmed or probable ARF
• no known past history of ARF.

Recurrent attack requires all of the following:

• strong clinical suspicion of ARF
• insufficient signs and symptoms to fulfil diagnosis of confirmed or probable ARF
• a past history of ARF or previously diagnosed rheumatic heart disease.

Probable -
Initial attack requires all of the following:

• evidence of preceding group A streptococcal infection from positive throat culture or rapid antigen test
• two major, or one major and two minor, manifestations (see Jones criteria)
• no known past history of ARF
  OR
• serological evidence of a preceding group A streptococcal infection (i.e. elevated or rising streptococcal titres)
• one major and one minor manifestation (see Jones criteria)
• no known past history of ARF.

Recurrent attack requires all of the following:

• evidence of preceding group A streptococcal infection from positive throat culture or rapid antigen test
• two major, or one major and two minor, manifestations (see Jones criteria)
• a past history of ARF or previously diagnosed rheumatic heart disease
  OR
• serological evidence of a preceding group A streptococcal infection (i.e. elevated or rising streptococcal titres)
• one major and one minor manifestation (see Jones criteria)
• a past history of ARF or previously diagnosed rheumatic heart disease.

Confirmed -
Initial attack requires all of the following:

• serological evidence of a preceding group A streptococcal infection (i.e. elevated or rising streptococcal titres)
• two major, or one major and two minor, manifestations (see Jones criteria)
• no known past history of ARF
  OR
• chorea (other major manifestations or evidence of group A streptococcal infection not required).

Recurrent attack requires all of the following:

• serological evidence of a preceding group A streptococcal infection (i.e. elevated or rising streptococcal titres)
• two major, or one major and two minor, or three minor, manifestations (see Jones criteria)
• a past history of ARF or previously diagnosed rheumatic heart disease.

For more information refer to the Rheumatic Fever section of the Communicable Disease Control Manual.