AUTHOR=Gherardi Giovanni , Vitali Luca Agostino , Creti Roberta 

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

JOURNAL=Frontiers in Public Health

VOLUME=6

YEAR=2018

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2018.00059

DOI=10.3389/fpubh.2018.00059

ISSN=2296-2565

ABSTRACT=<sec id="ST1"><title>Background</title><p><italic>Streptococcus pyogenes</italic> 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 (<italic>emm)</italic> gene typing is the most widely used genotyping method, with more than 200 <italic>emm</italic> types recognized. Molecular epidemiological data have been also used for the development of GAS M protein-based vaccines.</p></sec><sec id="ST2"><title>Methods</title><p>The aim of this paper was to provide an updated scenario of the most prevalent GAS <italic>emm</italic> 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 (“<italic>emm</italic>”) 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.</p></sec><sec id="ST3"><title>Results</title><p><italic>emm</italic>1 represented the dominant type in both Europe and North America, replaced by other <italic>emm</italic> types in only few occasions. The seven major <italic>emm</italic> types identified (<italic>emm</italic>1, <italic>emm</italic>28, <italic>emm</italic>89, <italic>emm</italic>3, <italic>emm</italic>12, <italic>emm</italic>4, and <italic>emm</italic>6) accounted for approximately 50–70% of the total isolates; less common <italic>emm</italic> types accounted for the remaining 30–50% of the cases. Most of the common <italic>emm</italic> types are included in either one or both the 26-valent and 30-valent vaccines, though some well-represented <italic>emm</italic> types found in Europe are not.</p></sec><sec id="ST4"><title>Conclusion</title><p>This study provided a picture of the prevalent <italic>emm</italic> types among invasive GAS (iGAS) in Europe and North America since the year 2000 onward. Continuous surveillance on the <italic>emm</italic>-type distribution among iGAS infections is strongly encouraged also to determine the potential coverage of the developing multivalent vaccines.</p></sec>