Group A streptococcal infections: burden and public health significance during the COVID-19 pandemic

Sažetak: Pojavom pandemije COVID-19 primjetan je pad respiratornih infekcija. Cilj ovoga rada jest prikazati incidenciju invazivnih i neinvazivnih bolesti uzrokovanih streptokokom skupine A u Hrvatskoj kroz tri godine prije pandemije (2017.-2019.) i tijekom tri godine pandemije (2020.-2022.). Studija je retrospektivna i uključuje sve bolesnike s dijagnosticiranom streptokoknom anginom, bakterijskim meningitisom, šarlahom, erizipelom i sepsom, upisane u Registar zaraznih bolesti Hrvatskog zavoda za javno zdravstvo, kao i sve prijavljene epidemije uzrokovane ovim uzročnikom. Prije pandemije uočen je značajno veći broj prijavljenih streptokoknih angina, šarlaha i erizipela u odnosu na tri godine pandemije (p = 0,0086, p = 0,0276, p = 0,0017). U doba prije pandemije u streptokoknoj angini i šarlahu bila je primjetna sezonalnost. Najveći broj oboljelih od angine zabilježen je između rujna i prosinca (p = 0,0003), dok je vrhunac za šarlah zabilježen između siječnja i ožujka (p = 0,0039). Međutim, nije bilo značajne razlike u broju prijavljenih pacijenata za bakterijsku sepsu i meningitis uzrokovane piogenim streptokokom između dva promatrana razdoblja. Zabilježeno je ukupno 35 epidemija streptokokne angine s 277 oboljelih i šest epidemija šarlaha s 51 oboljelim, a većina epidemija bila je u dječjim vrtićima (33 s 293 oboljelih), zatim u obiteljima (šest s 20 oboljelih) i školama ( dva s 15 bolesnika). Iako je tijekom pandemijskih godina uočen značajno manji broj streptokoknih neinvazivnih infekcija, popuštanjem nefarmakoloških mjera za suzbijanje širenja COVID-19 postoji mogućnost porasta broja oboljelih. Stoga je potrebno pomno pratiti kretanje streptokoka. Kako se epidemije streptokokne angine i šarlaha najčešće bilježe u vrtićima, dobra edukacija zaposlenika vrtića, praćenje pobola od strane vrtićkoga zdravstvenog osoblja, brza komunikacija s nadležnim epidemiologom te suradnja u provođenju preventivnih protuepidemijskih mjera, važni su u prekidu širenja infekcije. Za razliku od drugih bolesti koje se mogu iskorijeniti cjepivima, trenutno ne postoje dostupna cjepiva za bolesti izazvane piogenim streptokokom te one i dalje predstavljaju značajan izazov za zdravstvene djelatnike.With the emergence of the COVID-19 pandemic, there was a noticeable decrease in respiratory infections. The aim of this paper is to show the incidence of invasive and non-invasive diseases caused by group A streptococcus in Croatia during the three years before the pandemic (2017-2019) and during the three years of the pandemic (2020-2022). The study is retrospective and includes all patients diagnosed with streptococcal angina, bacterial meningitis, scarlet fever, erysipelas, and sepsis, registered in the Register of Infectious Diseases of the Croatian Institute of Public Health,as well as all reported outbreaks. Before the pandemic, a significantly higher number of reported streptococcal angina, scarlet fever and erysipelas was observed compared to the three years of the pandemic (p = 0.0086, p = 0.0276, p = 0.0017). In the pre-pandemic era, seasonality was noticeable in streptococcal angina and scarlet fever. The highest number of angina patients was recorded between September and December (p = 0.0003), while the peak for scarlet fever was recorded between January and March (p = 0.0039). However, there was no significant difference in the number of reported patients for bacterial sepsis and meningitis caused by pyogenic streptococcus between the two observed periods. A total of 35 epidemics of streptococcal angina with 277 patients and six epidemics of scarlet fever with 51 patients were recorded, and most of the epidemics were in kindergartens (33 with 293 patients), then in families (six with 20 patients) and schools (two with 15 patients). Although a significantly lower number of streptococcal non-invasive infections was observed during the pandemic, with the relaxation of non-pharmacological measures to prevent the spread of COVID-19, there is a possibility of an increase in the number of patients. Therefore, it is necessary to closely monitor the movement of streptococci. Since epidemics of streptococcal angina and scarlet fever are most often recorded in kindergartens, good education of kindergarten employees, monitoring of diseases by the kindergarten health staff, quick communication with the competent epidemiologist and cooperation in the implementation of preventive anti-epidemic measures are important in stopping the spread of infection. Unlike other diseases that can be eradicated by vaccines, there are currently no available vaccines for diseases caused by pyogenic streptococcus, and they continue to represent a significant challenge for health professionals