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

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.