• To assess the occurrence of acute rheumatic fever (RF) among the ethnic groups of Hawaii, the case records of hospitalized children with RF in Oahu were reviewed for the period from October 1976 to September 1980. One hundred four of the records met the modified Jones criteria. Incidence rates per 100,000 children were as follows: Japanese, 0; white, 9; Filipino, 9.1; Hawaiian and part-Hawaiian, 27.2; and Samoan, 96.5. Carditis was most common among Samoan children; it occurred in nine of 18 children. A streptococcal, throat culture program for children with respiratory Infections was in progress in 60% of Oahu's public schools during this period of time. Children with positive cultures were excluded from school until the start of treatment. However, RF occurred with equal frequency in participating and nonparticipating schools. Rheumatic fever continues to be a substantial problem among Polynesian children in Hawaii, and it is apparent that the school-based primary prevention program used In Hawaii to control streptococcal disease has not altered the frequency of RF among them.