During the recent decades the epidemiology of rheumatic fever has undergone significant changes in economically developed countries. Our observations in Hacettepe Children's Hospital for the last 20 years suggest that rheumatic fever is still an important problem in Turkey. It is difficult to determine the incidence of rheumatic fever accurately. In our study in Etimesgut area, where public health program has been applied for 40 years the incidence of rheumatic fever was found to be 20 per 100,000. The prevalence of rheumatic heart disease among school children of high socioeconomic levels is 2 per 1000.