620 - Pediatric Invasive Group A Streptococcus (GAS) Characteristics Before, During and After COVID-19

Publication Number: 620.6121

Katja Anuth, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Tsoline Kojaoghlanian, Maimonides Infants and Children's Hospital of Brooklyn, NEW YORK, NY, United States; Katheryn Cireseanu, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Areeba Qazi, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Jeremy Silverstein, Maimonides Infants and Children's Hospital of Brooklyn, New York, NY, United States; Maria Bhatti, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Rabia Agha, Maimonides Medical Center, Brooklyn, NY, United States

Background: Invasive GAS (iGAS) infections can occur in healthy children and are often associated with severe outcomes, including complicated pneumonia, necrotizing fasciitis, septic shock and even death. iGAS is confirmed with isolation of GAS from a sterile site. Since COVID-19-related social distancing measures have been lifted, iGAS disease has been reported at seemingly higher rates worldwide than in previous years.

Objective: We conducted a retrospective analysis of pediatric iGAS cases at our children’s hospital, a tertiary care center in an urban setting. Our aim was to assess differences, if any, in the characteristics of such patients before, during, and after the COVID-19 pandemic.

Design/Methods: We performed a retrospective chart review of patients 0-18 years of age hospitalized with iGAS. We divided the cases into 3 uneven time periods: period A, from January 2018 through December 2019, corresponding to two years preceding COVID-19; period B, from January 2020 through May 2022, during two and a half years of COVID-19 restrictions; and period C, encompassing the year after social distancing measures were lifted countrywide, from June 2022 through June 2023. We described and compared the number of iGAS cases, disease presentation and spectrum of complications, and other clinical differences during these 3 time periods. Emm typing was obtained, when possible, during period C.

Results: We identified 38 iGAS cases: 9 during period A, 11 during period B, and 18 during period C. The incidence in one post-pandemic year was double that of two years in the pre-pandemic period. The average age at presentation post-pandemic was also younger at 3.8 years, compared to 4.9 years during prior periods. iGAS has been typically reported to occur in winter months, which contrasts with our cases in period C where 61% occurred in the spring. Complicated skin and soft tissue infection was the predominant clinical presentation of iGAS during the pandemic. The severity of disease did not increase post-pandemic, as a smaller proportion of patients were admitted to intensive care or required vasopressors; however, the length of stay did not change over the three time periods. Two thirds of patients on whom emm typing was available had emm1.

Conclusion(s): After lifting COVID-19-related distancing measures, the number of iGAS cases increased at our hospital. The average age of infected children was lower than in pre-pandemic years, and there was a seasonality shift of cases from winter to spring. Our small sample size precluded non-descriptive statistical analysis. It remains to be seen if these trends in iGAS cases are sustained.