This research will provide evidence to support improved prevention of acute rheumatic fever (ARF). It will focus on a population at high risk of ARF: 5-14 year old children living in Porirua who have sore throats and skin infections and group A streptococcus (GAS) bacteria detected. GAS pharyngitis will be serologically confirmed to differentiate between children with true pharyngitis, who are considered at risk of progressing to ARF, from those that are GAS carriers. GAS organisms from throat and skin infections will be genetically typed (emm typing) to see if they are similar to those causing ARF in NZ. The study will collect data from participants to identify risk factors for infection, particularly those that are modifiable. This information will fill critical gaps in knowledge about the causes of NZ’s high rates of ARF, particularly the potential value of better treatment and improvements to the environments where children are living.