The Jones criteria have been the gold standard for acute rheumatic fever (ARF) diagnosis since 1944. In response to data revealing that these criteria lacked sensitivity in regions in which rheumatic heart disease (RHD) is endemic, in 2015, the American Heart Association published revisions that included separate criteria for high-risk settings, defined as settings with an ARF incidence of >2 per 100 000 children per year.1,2 However, to date, no prospective studies have evaluated the performance of these modified Jones criteria. We aimed to determine the specificity of the revised criteria by assessing the risk of developing RHD in children who presented with symptoms suggestive of ARF but did not meet the criteria for definite ARF under the revised standards.