INTRODUCTION AND METHODS. In Israel, as in most economically developed countries, rheumatic fever has become uncommon, although cases continue to be reported each year, particularly in the Arab population. In this observational survey, based on cases notified to, and investigated by, the Ministry of Health, we review the epidemiology of acute rheumatic fever in Israel in the decade 1981-90. RESULTS AND RECOMMENDATIONS. Where it persists in Israel, acute rheumatic fever remains commoner in non-Jews than in Jews and in males rather than in females, in children aged 5-14, and in children from relatively overcrowded and deprived homes. Despite the steady decline in rheumatic fever incidence in the past decade, its continued occurrence in Israel, and reports of outbreaks of acute rheumatic fever and virulent streptococcal infection in North America and Europe, demand that clinicians continue to treat streptococcal sore throats with full curative antibiotic doses, that confirmed cases receive extended chemoprophylaxis, and that surveillance and notification of acute rheumatic fever be continued.