BPSU - Acute Rheumatic Fever in children and young people ≤16 years of age in the UK and ROI

SCARF Logo.jpg

Surveillance of childhood acute rheumatic fever in children and young people 16 years of age and younger is commenced in May 2015. The study is being led by Dr Mary Salama of Birmingham Children's Hospital. This study is being funded through the Sir Peter Tizard Bursary for which Dr Salama was the winning applicant.

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Lead investigator

Dr Mary Salama
Department of General Paediatrics
Birmingham Children's Hospital
Steelhouse Lane
B4 6NH


Acute rheumatic fever (ARF) is a well recognised disease entity with clear diagnostic criteria. It occurs as a result of the body’s reaction to group A streptococcal infection. It is important to recognise as repeated infections are thought to impact on the development of chronic cardiac complications. Over the last 50 years its incidence in developed countries has decreased but it remains an important source of morbidity and mortality in the developing world.There is a lack of data from developed countries but mounting evidence suggests that it may be increasing in incidence again.

Surveillance of Childhood Acute Rheumatic Fever (SCARF) is an epidemiological study to identify all cases of ARF presenting in children aged 0-16 over a year period. The study team aim to explore demographic trends, mode of presentation, diagnostic criteria met, treatment and outcome.

Case definition: Please report any cases of children or young people 0-16 years of age with EITHER a confirmed OR suspected new diagnosis of acute rheumatic fever seen in the past month.

A confirmed ARF diagnosis requires:

  1. Evidence of recent group A streptococcal infection AND
  2. two major OR one major and two minor manifestations

Major manifestations

  • Carditis: (echocardiographic or clinically detected)
  • Polyarthritis (inflammation of two or more joints)
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules

Minor manifestations

  • Clinical findings: Arthralgia; Fever (≥38ºc)
  • Lab findings: Increased CRP (>20mg/L)/ESR (>20mm/hr)
  • Prolonged PR interval



This may present late and without lab / other clinical features of ARF and is enough alone to diagnose ARF if no other cause is found.


May 2015 to May 2016 (13 months of surveillance)


This study is being funded by the BPSU Sir Peter Tizard Bursary.

Ethical approval

This study has been approved by NRES Committee West Midlands - Solihull (REC reference: 13/WM/0412; IRAS ID: 128479) and has been granted Section 251 HRA-CAG permission (CAG reference: 13/WM/0412)

Support group

Further information