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Vieira A, Wan Y, Ryan Y, Li HK, Guy RL, Papangeli M, Huse KK, Reeves LC, Soo VWC, Daniel R, Harley A, Broughton K, Dhami C, Ganner M, Ganner MA, Mumin Z, Razaei M, Rundberg E, Mammadov R, Mills EA, Sgro V, Mok KY, Didelot X, Croucher NJ, Jauneikaite E, Lamagni T, Brown CS, Coelho J, Sriskandan S. Rapid expansion and international spread of M1 UK in the post-pandemic UK upsurge of Streptococcus pyogenes. Nat Commun 2024; 15:3916. [PMID: 38729927 PMCID: PMC11087535 DOI: 10.1038/s41467-024-47929-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
The UK observed a marked increase in scarlet fever and invasive group A streptococcal infection in 2022 with severe outcomes in children and similar trends worldwide. Here we report lineage M1UK to be the dominant source of invasive infections in this upsurge. Compared with ancestral M1global strains, invasive M1UK strains exhibit reduced genomic diversity and fewer mutations in two-component regulator genes covRS. The emergence of M1UK is dated to 2008. Following a bottleneck coinciding with the COVID-19 pandemic, three emergent M1UK clades underwent rapid nationwide expansion, despite lack of detection in previous years. All M1UK isolates thus-far sequenced globally have a phylogenetic origin in the UK, with dispersal of the new clades in Europe. While waning immunity may promote streptococcal epidemics, the genetic features of M1UK point to a fitness advantage in pathogenicity, and a striking ability to persist through population bottlenecks.
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Affiliation(s)
- Ana Vieira
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
| | - Yu Wan
- Department of Infectious Disease, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Yan Ryan
- Reference Services Division, UK Health Security Agency, London, UK
| | - Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Rebecca L Guy
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Maria Papangeli
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Kristin K Huse
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Lucy C Reeves
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Valerie W C Soo
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Roger Daniel
- Reference Services Division, UK Health Security Agency, London, UK
| | | | - Karen Broughton
- Reference Services Division, UK Health Security Agency, London, UK
| | - Chenchal Dhami
- Reference Services Division, UK Health Security Agency, London, UK
| | - Mark Ganner
- Reference Services Division, UK Health Security Agency, London, UK
| | | | - Zaynab Mumin
- Reference Services Division, UK Health Security Agency, London, UK
| | - Maryam Razaei
- Reference Services Division, UK Health Security Agency, London, UK
| | - Emma Rundberg
- Reference Services Division, UK Health Security Agency, London, UK
| | - Rufat Mammadov
- Reference Services Division, UK Health Security Agency, London, UK
| | - Ewurabena A Mills
- Department of Infectious Disease, Imperial College London, London, UK
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK
| | - Vincenzo Sgro
- Department of Infectious Disease, Imperial College London, London, UK
| | - Kai Yi Mok
- Department of Infectious Disease, Imperial College London, London, UK
| | - Xavier Didelot
- School of Life Sciences and Department of Statistics, University of Warwick, Coventry, UK
| | - Nicholas J Croucher
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Elita Jauneikaite
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Theresa Lamagni
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Colin S Brown
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK
| | - Juliana Coelho
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK.
- Healthcare-Associated Infections, Fungal, AMR, AMU, and Sepsis Division, UK Health Security Agency, London, UK.
- Reference Services Division, UK Health Security Agency, London, UK.
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK.
- Centre for Bacterial Resistance Biology, Imperial College London, London, UK.
- NIHR Health Protection Research Unit in Healthcare-associated Infections and AMR, Imperial College London, London, UK.
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Chiang-Ni C, Hsu CY, Yeh YH, Chi CY, Wang S, Tsai PJ, Chiu CH. Detection of toxigenic M1 UK lineage group A Streptococcus clones in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:269-277. [PMID: 38278671 DOI: 10.1016/j.jmii.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND A new sublineage of emm1 group A Streptococcus (GAS), M1UK, has emerged in Europe, North America, and Australia. Notably, a significant portion of emm1 isolates in Asia, particularly in Hong Kong and mainland China, acquired scarlet fever-associated prophages following the 2011 Hong Kong scarlet fever outbreak. However, the presence of the M1UK sublineage has not yet been detected in Asia. METHODS This study included 181 GAS isolates (2011-2021). The emm type of these isolates were determined, and 21 emm1 isolates from blood or pleural fluid (2011-2021) and 10 emm1 isolates from throat swabs (2016-2018) underwent analysis. The presence of the scarlet fever-associated prophages and the specific single nucleotide polymorphisms of the M1UK clone were determined by polymerase chain reaction and the genome sequencing. RESULTS The M1UK lineage strains from throat swab and blood samples were identified. One of the M1UK strain in Taiwan carried the scarlet fever-associated prophage and therefore acquired the ssa, speC, and spd1 toxin repertoire. Nonetheless, the increase of M1UK was not observed until 2021, and there was a reduction in the diversity of emm types in 2020-2021, possibly due to the COVID-19 pandemic restriction policies in Taiwan. CONCLUSIONS Our results suggested that the M1UK lineage clone has introduced in Taiwan. In Taiwan, the COVID-19 restrictions were officially released in March 2023; therefore, it would be crucial to continuously monitor the M1UK expansion and its related diseases in the post COVID-19 era.
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Affiliation(s)
- Chuan Chiang-Ni
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Chih-Yun Hsu
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Yeh
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yu Chi
- National Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Zhunan, Miaoli, Taiwan; Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shuying Wang
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Jane Tsai
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Hsun Chiu
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Cui J, Zhang Y, Ge H, Cao Y, Su X. Patterns in the Incidence of Scarlet Fever Among Children Aged 0-9 Years - China, 2010-2019. China CDC Wkly 2023; 5:756-762. [PMID: 37692760 PMCID: PMC10485360 DOI: 10.46234/ccdcw2023.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction This study investigates the patterns of scarlet fever among Chinese children aged 0-9 years from 2010 to 2019. The objective is to provide insights that may inform potential adjustments to China's current prevention and control tactics for this illness. Methods The present study utilized data on the occurrence of scarlet fever in children from 2010 to 2019, sourced from the National Notifiable Disease Reporting System database, managed by the Chinese Center for Disease Control and Prevention. This research implemented SAS9.4 software to construct trajectory models representing the temporal incidence of scarlet fever, accounting for key variables such as sex, geographic region, urban versus rural dwellings, and various age brackets. Results From 2010 to 2019, a total of 554,695 scarlet fever cases were reported among children aged 0-9 years in the 31 mainland Chinese provincial-level administrative divisions, signifying a rate of 35.36 per 100,000 individuals. An inconsistent yet generally rising trend was observed, evidenced by a 3.17-fold increase in reported cases and a 3.02-fold escalation in incidence rate over this period. Examination of these trends revealed three distinctive developmental patterns for both males and females, with the lowest prevalence in the first trajectory and the highest in the third. The incidence was consistently higher among males than females in all trajectories. The urban and northern regions displayed equal or greater trajectory rates than their rural and southern counterparts, respectively. In terms of age groups, the lowest incidence was observed in the 0-1-year age group, while the highest was recorded in the 4-5 and 6-7-year age groups. Conclusions Between 2010 and 2019, there was a marked increase in the incidence of scarlet fever among children in China. The disease predominantly impacts urban-dwelling children, ranging from 4 to 7 years old, in the northern regions of the country. The incidence is reported to be higher among boys compared to girls.
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Affiliation(s)
- Jinyu Cui
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yewu Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Ge
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Cao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuemei Su
- Chinese Center for Disease Control and Prevention, Beijing, China
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Davies MR, Keller N, Brouwer S, Jespersen MG, Cork AJ, Hayes AJ, Pitt ME, De Oliveira DMP, Harbison-Price N, Bertolla OM, Mediati DG, Curren BF, Taiaroa G, Lacey JA, Smith HV, Fang NX, Coin LJM, Stevens K, Tong SYC, Sanderson-Smith M, Tree JJ, Irwin AD, Grimwood K, Howden BP, Jennison AV, Walker MJ. Detection of Streptococcus pyogenes M1 UK in Australia and characterization of the mutation driving enhanced expression of superantigen SpeA. Nat Commun 2023; 14:1051. [PMID: 36828918 PMCID: PMC9951164 DOI: 10.1038/s41467-023-36717-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
A new variant of Streptococcus pyogenes serotype M1 (designated 'M1UK') has been reported in the United Kingdom, linked with seasonal scarlet fever surges, marked increase in invasive infections, and exhibiting enhanced expression of the superantigen SpeA. The progenitor S. pyogenes 'M1global' and M1UK clones can be differentiated by 27 SNPs and 4 indels, yet the mechanism for speA upregulation is unknown. Here we investigate the previously unappreciated expansion of M1UK in Australia, now isolated from the majority of serious infections caused by serotype M1 S. pyogenes. M1UK sub-lineages circulating in Australia also contain a novel toxin repertoire associated with epidemic scarlet fever causing S. pyogenes in Asia. A single SNP in the 5' transcriptional leader sequence of the transfer-messenger RNA gene ssrA drives enhanced SpeA superantigen expression as a result of ssrA terminator read-through in the M1UK lineage. This represents a previously unappreciated mechanism of toxin expression and urges enhanced international surveillance.
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Affiliation(s)
- Mark R Davies
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
| | - Nadia Keller
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Stephan Brouwer
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Magnus G Jespersen
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Amanda J Cork
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew J Hayes
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Miranda E Pitt
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - David M P De Oliveira
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Nichaela Harbison-Price
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Olivia M Bertolla
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Daniel G Mediati
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Bodie F Curren
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - George Taiaroa
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jake A Lacey
- Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Helen V Smith
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Queensland Health, Coopers Plains, QLD, Australia
| | - Ning-Xia Fang
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Queensland Health, Coopers Plains, QLD, Australia
| | - Lachlan J M Coin
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Kerrie Stevens
- Microbiological Diagnostic Unit Public Health Laboratory, The Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Martina Sanderson-Smith
- Illawarra Health and Medical Research Institute and Molecular Horizons, School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, NSW, Australia
| | - Jai J Tree
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Adam D Irwin
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia.,Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Amy V Jennison
- Public Health Microbiology, Queensland Health Forensic and Scientific Services, Queensland Health, Coopers Plains, QLD, Australia
| | - Mark J Walker
- Australian Infectious Diseases Research Centre and School of Chemistry and Molecular Biosciences and Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
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Li H, Zhou L, Zhao Y, Ma L, Zhang H, Liu Y, Liu X, Hu J. Epidemiological analysis of Group A streptococcus infection diseases among children in Beijing, China under COVID-19 pandemic. BMC Pediatr 2023; 23:76. [PMID: 36782167 PMCID: PMC9923647 DOI: 10.1186/s12887-023-03885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Group A streptococcus is human-restricted gram-positive pathogen, responsible for various clinical presentations from mild epidermis infections to life threatened invasive diseases. Under COVID-19 pandemic,. the characteristics of the epidemic strains of GAS could be different. PURPOSE To investigate epidemiological and molecular features of isolates from GAS infections among children in Beijing, China between January 2020 and December 2021. Antimicrobial susceptibility profiling was performed based on Cinical Laboratory Sandards Institute. Distribution of macrolide-resistance genes, emm types, and superantigens was examined by polymerase chain reaction. RESULTS 114 GAS isolates were collected which were frequent resistance against erythromycin (94.74%), followed by clindamycin (92.98%), tetracycline (87.72%). Emm12 (46.49%), emm1 (25.44%) were dominant emm types. Distribution of ermB, ermA, and mefA gene was 93.85%, 2.63%, and 14.04%, respectively. Frequent superantigenes identified were smeZ (97.39%), speG (95.65%), and speC (92.17%). Emm1 strains possessed smeZ, ssa, and speC, while emm12 possessed smeZ, ssa, speG, and speC. Erythromycin resistance was predominantly mediated by ermB. Scarlet fever strains harbored smeZ (98.81%), speC (94.05%). Impetigo strains harbored smeZ (88.98%), ssa (88.89%), and speC (88.89%). Psoriasis strains harbored smeZ (100%). CONCLUSIONS Under COVID-19 pandemic, our collections of GAS infection cutaneous diseases decreased dramatically. Epidemiological analysis of GAS infections among children during COVID-19 pandemic was not significantly different from our previous study. There was a correlation among emm, superantigen gene and disease manifestations. Long-term surveillance and investigation of emm types and superantigens of GAS prevalence are imperative.
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Affiliation(s)
- Hongxin Li
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China.
| | - Lin Zhou
- grid.459434.bDepartment of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Yong Zhao
- grid.414252.40000 0004 1761 8894Department of Reproductive Medicine, Senior Department of Obstetrics & Gynecology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lijuan Ma
- grid.459434.bDepartment of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Haihua Zhang
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Yan Liu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Xiaoyan Liu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
| | - Jin Hu
- grid.459434.bDepartment of Dermatology, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020 China
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Jespersen MG, Lacey JA, Tong SYC, Davies MR. Global genomic epidemiology of Streptococcus pyogenes. INFECTION GENETICS AND EVOLUTION 2020; 86:104609. [PMID: 33147506 DOI: 10.1016/j.meegid.2020.104609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023]
Abstract
Streptococcus pyogenes is one of the Top 10 human infectious disease killers worldwide causing a range of clinical manifestations in humans. Colonizing a range of ecological niches within its sole host, the human, is key to the ability of this opportunistic pathogen to cause direct and post-infectious manifestations. The expansion of genome sequencing capabilities and data availability over the last decade has led to an improved understanding of the evolutionary dynamics of this pathogen within a global framework where epidemiological relationships and evolutionary mechanisms may not be universal. This review uses the recent publication by Davies et al., 2019 as an updated global framework to address S. pyogenes population genomics, highlighting how genomics is being used to gain new insights into evolutionary processes, transmission pathways, and vaccine design.
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Affiliation(s)
- Magnus G Jespersen
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jake A Lacey
- Doherty Department, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Steven Y C Tong
- Doherty Department, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, VIC, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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