Background: Between 2020-2022, many countries observed rises in iGAS and scarlet fever following easing of Covid-19 mitigations. However, less has been reported on the impact of the pandemic on superficial and immune-mediated Group A Streptococcal (Strep A) conditions. This study examines trends in acute rheumatic fever (ARF) and Strep A skin and throat infections in Auckland, New Zealand, before and after the pandemic.

Methods: A retrospective analysis (2018-2024) used administrative data from the Auckland region, including culture results from over 1.53 million throat and skin swabs collected in primary care and ARF notifications from the national notifiable disease surveillance database (EpiSurv).

Results: Significant increases in Strep A swab positivity and reported ARF cases were observed in 2023, with trends continuing into 2024, surpassing pre-pandemic swab positivity and ARF rates. Across all years, ARF and Strep A throat and skin swab positivity were highest in autumn. Strep A swab positivity was highest in 5–9-year-olds while ARF case notifications were highest in children aged 10-14 years, followed by 5–9-year-olds. Strep A skin positivity was highest among Māori and Pacific peoples, who also accounted for nearly all (99%) ARF cases.

Conclusion: This large longitudinal dataset demonstrates that Strep A throat and skin infections parallel ARF notifications in New Zealand. Reducing community skin and throat infections through primary and public health interventions and a future vaccine, may help decrease serious Strep A outcomes such as ARF. This finding highlights the value of surveillance across the spectrum of Strep A diseases within a single population.