Rheumatic fever cases in Tai Tokerau are showing no sign of dropping, despite the rollout of screening programmes in schools.
Fifty-four schools across the region are now throat-swabbing pupils for the Strep-A bug, which causes the disease.
Medical Officer of Health Claire Mills says there have been 12 notified cases already this year, compared with 15 for the whole of 2012.
She says all have been Maori, and some were children on the verge of heart failure who needed immediate surgery.
Dr Mills says screening alone won't stop the disease. She says rheumatic fever is linked to overcrowding, poor access to doctors and low incomes and in rural areas there's no sign that's changing.
She says efforts being made in the health sector to identify the Strep-A bug and try to isolate it, before it comes in contact with children who are at high risk of contracting it.
Northland District Health Board says a more strategic approach is required than throat-swabbing.
A doctor in Mangere, Michael Wilson, agrees, saying dealing with factors such as overcrowded housing need to be addressed if rates are to fall.
Dr Wilson says his clinic is seeing an unacceptable number of children with rheumatic fever.
A Ministry of Health report shows an overall increase in the number of cases nationally from 2004 to 2012, with 164 cases reported last year.