South Korea sees surge in pediatric invasive Group A Strep infections post-pandemic

The incidence of invasive Group A Streptococcus (iGAS) infections in children in South Korea has rapidly rebounded to pre-pandemic levels following the relaxation of COVID-19 restrictions, according to a decade-long analysis by researchers at Bundang Seoul National University Hospital. The study, published in The Lancet Regional Health Western Pacific, analyzed 454 iGAS patients across 23 university hospitals from 2015 to 2024.

During the COVID-19 pandemic, pediatric iGAS cases dropped by approximately 90%, from 9.34 per 100,000 children to 0.95. However, in 2023-2024, the rate surged to 10.45 per 100,000. In contrast, adult iGAS cases decreased from 6.57 to 1.83 during the pandemic and then rose to only 2.47. While less frequent, iGAS can be life-threatening, potentially leading to sepsis, necrotizing fasciitis, or toxic shock syndrome, particularly in vulnerable populations.

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The study is significant as it is the first nationwide analysis of the 10-year incidence and clinical characteristics of invasive Group A Streptococcus infections in Korea. Especially since cases in pediatric patients have significantly increased after the pandemic and the M1UK strain has been confirmed in Korea, continuous monitoring of changes in epidemic patterns is necessary.

The study also identified a new variant, M1UK, which has been spreading internationally, for the first time in South Korea. This finding strengthens the argument for a national surveillance system capable of monitoring not only the number of iGAS cases but also their severity and the genetic evolution of the bacteria. Early detection of emerging strains and infection clusters is crucial for public health.

Professor Kim Ye-kyung emphasized the significance of the nationwide analysis of iGAS trends and clinical characteristics over the past decade. She highlighted the need for continuous monitoring of evolving epidemic patterns, especially given the post-pandemic surge in pediatric cases and the detection of the M1UK strain. Professor Lee Hyun-joo added that while Group A Streptococcus is common, invasive forms can rapidly worsen even healthy individuals, underscoring the need for discussions on establishing a more active surveillance system, potentially by registering invasive iGAS as a legally communicable disease.

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Group A Streptococcus is a common bacterium, so people tend to be less vigilant, but when it manifests invasively, even healthy individuals can deteriorate rapidly in a short period. Discussions are needed to build a more active surveillance system, such as registering invasive Group A Streptococcus infections as a legally communicable disease.