AIM An audit of rheumatic fever surveillance in Northland was carried out for the period 2002-2011. The aim of the audit was to establish the accuracy and completeness of surveillance of Acute Rheumatic Fever in Northland, and to provide a robust baseline for future comparison given current rheumatic fever prevention efforts. METHODS Cases of acute rheumatic fever (2002-2011) were identified and evaluated through auditing Northland hospital discharges, the Northland Rheumatic Fever secondary penicillin prophylaxis register and the national EpiSurv database. Cases were included in the audit if they met diagnostic criteria according to the 2008 Heart Foundation guidelines. RESULTS A total of 114 acute rheumatic fever cases met the audit criteria, an annualised incidence of 7.7/100,000 in Northland. 95% of all cases were Maori with a large disparity between Maori (24.8/100,000) and non-Maori (0.6/100,000). Acute rheumatic fever cases were strongly associated with living in high deprivation areas. This audit noted both under- and over-notification of acute rheumatic fever. CONCLUSION Acute rheumatic fever rates in Northland Maori children aged 5-14 (78/100000) are similar to those seen in developing countries and nearly double the rates seen other New Zealand audits. The findings highlight the urgent need to address crowding, poverty and inequitable primary care access if rheumatic fever is to be eliminated.