Temporal trends in pediatric group A streptococcal pharyngitis across the coronavirus disease 2019 era: A large retrospective cohort study.

Authors

Yunus Nas, Süveyda Gözüküçük, Hilmi Bayırlı, Basri Çakıroğlu

Published in

The Journal of international medical research. Volume 54. Issue 8. Pages 3000605261475117. Epub Aug 24, 2026.

Abstract

ObjectıveThe coronavirus disease 2019 pandemic and associated non-pharmaceutical interventions, including school closure, mask use, and social distancing, substantially altered the epidemiology of pediatric respiratory infections. However, their impact on pediatric Group A Streptococcus pharyngitis remains incompletely understood. This study evaluated temporal trends in Group A Streptococcus positivity across the coronavirus disease 2019 era and factors independently associated with Group A Streptococcus positivity.MethodsIn this retrospective cohort study, pediatric patients aged 0-18 years presenting with suspected acute tonsillopharyngitis at a tertiary pediatric outpatient clinic between October 2018 and December 2025 were evaluated. Group A Streptococcus positivity was defined based on a positive rapid antigen detection test and/or positive throat culture for Streptococcus pyogenes. Patients were categorized into pre-pandemic (October 2018 to February 2020), pandemic (March 2020 to May 2023), and post-pandemic (June 2023 to December 2025) periods. Group A Streptococcus positivity rates were compared using chi-square tests, and multivariable logistic regression adjusted for epidemiological period, age, sex, and diagnostic method was performed.ResultsIn total, 24,166 deduplicated clinical episodes were included. Group A Streptococcus positivity increased significantly across the three epidemiological periods, from 19.7% in the pre-pandemic period to 28.4% during the pandemic and 35.1% in the post-pandemic period (p < 0.001). Compared with the pandemic period (reference category), the post-pandemic period was independently associated with higher odds of Group A Streptococcus positivity (odds ratio, 1.37; 95% confidence interval, 1.29-1.46; p < 0.001), whereas the pre-pandemic period was associated with lower odds (odds ratio, 0.66; 95% confidence interval, 0.61-0.71; p < 0.001). Increasing age (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; p < 0.001) and male sex (odds ratio, 1.08; 95% confidence interval, 1.02-1.14; p = 0.005) were also independently associated with Group A Streptococcus positivity.ConclusionsGroup A Streptococcus positivity increased progressively across the coronavirus disease 2019 era. These trends likely reflect combined effects of healthcare utilization, diagnostic testing practices, age distribution, and transmission dynamics rather than a single explanatory mechanism. Continued epidemiological surveillance is needed to better understand pediatric Group A Streptococcus pharyngitis.

PMID:
42635996
Bibliographic data and abstract were imported from PubMed on 25 Aug 2026.

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