Rheuamtic fever and rheumatic heart disease are still important public health problems in Israel. Rheumatic fever is a seasonal disease, more common during the cold months of the year. A high incidence of rheumatic fever followed the immigration waves of the 1950s, in contrast with a decline in new cases over the last 10 years among both Jews and non-Jews. In the same period (1950s to 1975), a decline in the numbers of hospitalized patients was also reported. After 1970 mortality rates of rheumatic fever dropped to zero. The prevalence of rheumatic heart disease has declined in children, as shown in school studies, but in adults, a different trend is seen. The number of hospitalized patients has increased, in parallel with the increasing population, to more than 3,000 hospitalized patients per year. While a plateau curve is seen in the mortality rates of males of all ethnic origins studied, among females there is a slight decline in mortality. The discrepancy between the decline in occurrence of rheumatic fever and rheumatic heart disease in children and the increase in prevalence of rheumatic heart disease in adults is explained by the massive immigration from countries with a high prevalence of rheumatic heart disease.