Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000

Abstract

BackgroundStreptococcus pyogenes or group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections, from uncomplicated to more severe and invasive diseases with high mortality and morbidity. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern; for this purpose the M protein gene (emm) gene typing is the most widely used genotyping method, with more than 200 emm types recognized. Molecular epidemiological data have been also used for the development of GAS M protein-based vaccines.MethodsThe aim of this paper was to provide an updated scenario of the most prevalent GAS emm types responsible for invasive infections in developed countries as Europe and North America (US and Canada), from 1st January 2000 to 31st May 2017. The search, performed in PubMed by the combined use of the terms (“emm”) and (“invasive”) retrieved 264 articles, of which 38 articles (31 from Europe and 7 from North America) met the inclusion criteria and were selected for this study. Additional five papers cited in the European articles but not retrieved by the search were included.Resultsemm1 represented the dominant type in both Europe and North America, replaced by other emm types in only few occasions. The seven major emm types identified (emm1, emm28, emm89, emm3, emm12, emm4, and emm6) accounted for approximately 50–70% of the total isolates; less common emm types accounted for the remaining 30–50% of the cases. Most of the common emm types are included in either one or both the 26-valent and 30-valent vaccines, though some well-represented emm types found in Europe are not.ConclusionThis study provided a picture of the prevalent emm types among invasive GAS (iGAS) in Europe and North America since the year 2000 onward. Continuous surveillance on the emm-type distribution among iGAS infections is strongly encouraged also to determine the potential coverage of the developing multivalent vaccines.

Molecular epidemiology and antimicrobial resistance of group A streptococcus recovered from patients in Beijing, China

“…emm1 is the most popular type in Germany, consistent with that in the USA, Australia, and Japan; the prevalent types were emm1 (31.8%), emm28 (15.4%), and emm 89 (14.5%) [14,32]. Presently, the most popular emm types in China are emm12 and emm1.…”

Neonatal Group A Streptococcus Meningitis. Case Report and Literature Review

“…[22,23] The diagnosis of GAS meningitis in our case is further strengthened by the mother's positive throat swab which revealed the same GAS subtype as that of the neonate's CSF culture. Several recently published epidemiological studies [24][25][26] have revealed that the emm1.0 subtype identified in our case is the most prevalent subtype causing invasive GAS infections, and specifically meningitis, in the majority of European and North American countries. Moreover, emm1.0 is associated with death from invasive GAS infections at all ages.…”

From hidden outbreaks to epidemic emergencies: the threat associated with neglecting emerging pathogens

“…For the last two decades, a significant increase in the number of invasive infections has been seen in certain regions of North America and Europe. Gheradi et al [95] have shown several serotypes have increased their circulation in these areas. While between 50 and 70% have been associated with one particular serotype, emm1, the risk of complications associated with the other serotypes, including known invasive members such as emm3, emm12 and emm28 [96] as well as emm59 [97] and emm89 [98].…”