Impact of the COVID‑19 Pandemic on Group A Streptococcal Infections, Acute Rheumatic Fever and Rheumatic Heart Disease in US Youth: Trends and Social Vulnerability.

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.