Elimination of rheumatic heart disease (RHD) as a public health problem requires a multifaceted approach, including better primordial and primary prevention and early case detection and treatment of rheumatic fever, the autoimmune precursor to RHD. Here, we reflect on progress made in the decade since the 2015 revision of the Jones Criteria for rheumatic fever diagnosis. Advances in understanding rheumatic fever pathophysiology, the identification of potential biomarkers and improved clinical insights are bringing us closer to a diagnostic test for rheumatic fever and to targeted treatments that could prevent progression to RHD.