Key result
COVID-19 linked to early ~21% drop in GAS positivity and ARF/RHD, followed by isolated GAS rebound.
Why the study?
The COVID-19 pandemic affected exposure to infectious agents, but its impact on Group A streptococcal infections, acute rheumatic fever, and rheumatic heart disease prevalence remained unexamined.
Did the COVID-19 pandemic affect the prevalence of Group A streptococcal infections, acute rheumatic fever, and rheumatic heart disease in US youth?
Observational
Yes
Did the COVID-19 pandemic affect the prevalence of Group A streptococcal infections, acute rheumatic fever, and rheumatic heart disease in US youth?
Absolute Event Rate: 12.3% vs 15.5%
p-value: p=< 0.001
The COVID-19 pandemic was associated with a significant reduction in GAS, ARF, and RHD diagnoses in US youth, with ARF and RHD remaining stable despite a late-pandemic surge in GAS.
Early-pandemic GAS positivity decline was associated with lower ARF/RHD rates; extends surveillance data but remains hypothesis-generating.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected exposure to infectious agents. We aimed to analyze changes in Group A streptococcal (GAS), acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence during the COVID-19 pandemic and assess associated social vulnerability indices (SVI). METHODS: Using the Epic Cosmos database, we performed a descriptive analysis of patients aged 2-21 in the United States from January 2016 through December 2023. We compared monthly GAS positivity rates and ARF/RHD diagnosis frequencies across pre-pandemic (January 2016-February 2020), early-pandemic (March 2020-August 2022), and late-pandemic (September 2022-December 2023) periods, incorporating Centers for Disease Control-derived SVI themes. RESULTS: GAS positivity significantly decreased from pre-pandemic (15.5%; 838 tests/100,000) to early pandemic (12.3%; 363; P < 0.001), then rebounded in the late pandemic (20.8%; 1340; P < 0.001). Among 412 ARF and 780 RHD patients, early pandemic diagnoses dropped significantly for ARF (0.87-0.56 per 100,000; P < 0.001) and RHD (0.54-0.43; P = 0.003). Neither showed a significant late-pandemic resurgence (ARF 0.60, P = 0.915; RHD 0.40, P = 0.182). Compared with >29 million controls, RHD patients showed higher vulnerability across all SVI themes, while ARF patients were more vulnerable in Racial and Ethnic Minority Status, Housing Type and Transportation. CONCLUSIONS: This study identifies a significant reduction in GAS, ARF and RHD during the pandemic. Despite a late-pandemic surge in GAS infections, ARF and RHD diagnoses remained stable. These findings highlight a potential decline in overall ARF and RHD diagnoses and identify specific social vulnerability targets for public health intervention in the United States.
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West et al. (2026) conducted an observational in Group A streptococcal infections, acute rheumatic fever, and rheumatic heart disease. COVID-19 pandemic periods vs. Pre-pandemic period was evaluated on Group A streptococcal (GAS) positivity rate (p=< 0.001). The COVID-19 pandemic was associated with an early decrease in GAS positivity (15.5% to 12.3%, P<0.001) and ARF/RHD diagnoses, followed by a late-pandemic GAS rebound without an ARF/RHD resurgence.
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