Abstract
Background Streptococcus pyogenes (Group A Streptococcus, GAS) is a significant pathogen that causes diverse infections, ranging from pharyngitis to severe invasive diseases. Asymptomatic carriage in children is pivotal for transmission. The COVID-19 pandemic's health measures, including mask wearing and enhanced hand hygiene, likely influenced GAS transmission dynamics. This study evaluated the impact of these precautions on the prevalence of asymptomatic pharyngeal GAS carriage among schoolchildren in the southern West Bank, Palestine.Methods This cross-sectional study was conducted in two phases: pre-COVID-19 (November 2019 - January 2020) and post-COVID-19 (November 2023 - April 2024). Throat swabs from 701 children (345 pre-COVID-19, 356 post-COVID-19) were collected using cluster sampling. The samples were tested using the ABON Strep A rapid test and confirmed by culture. Sociodemographic, health, and household data were gathered. The statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression.Results The prevalence of asymptomatic GAS carriage significantly decreased from 15.7% in 2019 to 10.4% in 2024 (p = 0.038). The gender distribution remained stable (p = 0.662), while urban residence increased significantly from 34.5–41.6% (p = 0.050). The use of private wells for drinking water increased from 17.7–32.0% (p < 0.001), with private well users having greater odds of GAS carriage than municipal water users (adjusted OR = 4.128, 95% CI: 2.175–7.830, p < 0.001). Consistent hand hygiene was associated with lower odds of carriage (adjusted OR = 0.367, 95% CI: 0.184–0.730, p < 0.001), and regular teeth brushing also significantly reduced odds (adjusted OR for brushing twice daily = 0.055, 95% CI: 0.019–0.157, p < 0.001).Conclusions COVID-19-related health precautions were correlated with a significant reduction in asymptomatic GAS carriage among Palestinian children. These findings suggest that public health measures, such as mask wearing and hand hygiene, can influence the transmission of respiratory pathogens. Ongoing surveillance and targeted interventions are essential for managing GAS infections, particularly in resource-limited settings.