The Impact of the COVID-19 Pandemic on Invasive Group A Streptococcal Infections in Children

Aim: The aim of this study was to evaluate the impact of the coronavirus disease-2019 pandemic on the invasive group A Streptococcus (iGAS) infections in children. We also aimed to assess the demographic and clinical characteristics, and treatment outcomes of children with iGAS infections. Materials and Methods: We conducted a retrospective analysis of the medical records for pediatric patients aged 1 month to 18 years who were diagnosed with iGAS infections and followed by a single pediatric infectious diseases department from January 2010 to December 2021. The study period was divided into two periods: the pre-pandemic period (January 2010-February 2020) and the pandemic period (March 2020-December 2021). Results: A total of 40 patients (60% female) with a median age of 8 years (1-17 years) were included in this study. Among these, 20 had bacteremia, 13 patients had necrotizing soft tissue infection, 4 had pneumonia and empyema, 2 had septic arthritis, and 1 had acute bacterial meningitis. Two patients developed streptococcal toxic shock syndrome. In 6 patients, varicella infection, and in 4 patients, influenza infection preceded iGAS infection. The distribution of patients by year was as follows: 2 patients in 2010, 2011, and 2012; 3 in 2013; 0 in 2014; 4 in 2015; 6 in 2016 and 2017; 7 in 2018; and 8 in 2019, indicating a progressive increase in iGAS cases towards the last years of the pre-pandemic period. No cases were observed during the pandemic period. Three patients died. Conclusion: Our study found that the number of iGAS cases progressively increased in the last years of the pre-pandemic period, while no cases were observed during the pandemic period. This may be attributed to a reduction in GAS transmission due to the preventive measures implemented during the pandemic, as well as a decrease in the incidence of infections such as influenza and varicella, which are significant risk factors for iGAS.