{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:10:35Z","timestamp":1791897035416,"version":"4.3.4"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250154-4\"><jats:title>Importance<\/jats:title><jats:p>The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250154-5\"><jats:title>Objective<\/jats:title><jats:p>To describe the epidemiology of pediatric iGAS over a 32-year period.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250154-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including <jats:italic>emm<\/jats:italic> typing from Canada\u2019s National Microbiology Laboratory and population data from Statistics Canada. All children (age &amp;amp;lt;18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250154-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting <jats:italic>emm<\/jats:italic> types; and antimicrobial resistance.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250154-8\"><jats:title>Results<\/jats:title><jats:p>Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100\u202f000 population per year in 1992 to 2011 to 2.4 events per 100\u202f000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100\u202f000 population per year in 2020 and 0.5 events per 100\u202f000 population per year in 2021 before increasing to 6.0 events per 100\u202f000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (<jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common <jats:italic>emm<\/jats:italic> types were <jats:italic>emm<\/jats:italic>1 (182 of 471 isolates [38.6%]), <jats:italic>emm<\/jats:italic>12 (75 isolates [15.9%]<jats:italic>),<\/jats:italic> and <jats:italic>emm<\/jats:italic>4 (31 isolates [6.6%]). The M1<jats:sub>UK<\/jats:sub> subtype was first identified in 2019 and comprised 32 of 46 <jats:italic>emm<\/jats:italic>1 isolates (70.0%) from 2019 to 2023. Compared with other <jats:italic>emm<\/jats:italic> types, <jats:italic>emm<\/jats:italic>1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); <jats:italic>emm<\/jats:italic>4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of <jats:italic>emm<\/jats:italic> types included in the 30-valent GAS vaccine.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi250154-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This case series found that pediatric iGAS incidence increased in south-central Ontario prior to and after the COVID-19 pandemic in association with increased iGAS infections of the respiratory tract. Respiratory viral coinfections were common. Different <jats:italic>emm<\/jats:italic> types were associated with differing presentations and severity.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.2861","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T23:53:24Z","timestamp":1743724404000},"page":"e252861","source":"Crossref","is-referenced-by-count":26,"title":["Invasive Group A Streptococcal Infection in Children, 1992-2023"],"prefix":"10.1001","volume":"8","author":[{"given":"Halima","family":"Dabaja-Younis","sequence":"first","affiliation":[{"name":"Infection Prevention and Control Unit, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Kandel","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Johnstone","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control Unit, Sinai Health, Toronto, Ontario, Canada"},{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Kassee","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Toronto Public Health, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahin","family":"Baqi","sequence":"additional","affiliation":[{"name":"William Osler Health System, Brampton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Barker","sequence":"additional","affiliation":[{"name":"Trillium Health Partners, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Bitnun","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Borgia","sequence":"additional","affiliation":[{"name":"William Osler Health System, Brampton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Campigotto","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumon","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Trillium Health Partners, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne L.","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa","family":"Golden","sequence":"additional","affiliation":[{"name":"National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Kitai","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne","family":"Kus","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, Toronto, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Martin","sequence":"additional","affiliation":[{"name":"National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Muller","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Unity Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeya","family":"Nadarajah","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Oak Valley Health, Markham, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystyna","family":"Ostrowska","sequence":"additional","affiliation":[{"name":"Trillium Health Partners, Mississauga, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ricciuto","sequence":"additional","affiliation":[{"name":"Lakeridge Health, Oshawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Richardson","sequence":"additional","affiliation":[{"name":"William Osler Health System, Brampton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medina","family":"Saffie","sequence":"additional","affiliation":[{"name":"Joseph Brant Hospital, Burlington, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Tadros","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Tyrrell","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada"},{"name":"Alberta Precision Laboratories, Edmonton, Alberta, Canada"},{"name":"Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monali","family":"Varia","sequence":"additional","affiliation":[{"name":"Region of Peel \u2013 Public Health, Brampton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda","family":"Almohri","sequence":"additional","affiliation":[{"name":"Lifelabs, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiva","family":"Barati","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Crowl","sequence":"additional","affiliation":[{"name":"Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario, Canada"},{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubna","family":"Farooqi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Lefebvre","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel Xinliu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mare","family":"Pejkovska","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asfia","family":"Sultana","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Vikulova","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazi","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agron","family":"Plevneshi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"McGeer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Toronto Invasive Bacterial Diseases Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelbaset","family":"Belhaj","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Lovinsky","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Rose","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Chen","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramzi","family":"Fattouh","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigmund","family":"Krajden","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"Matukas","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Goneau","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alainna","family":"Jamal","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amna","family":"Faheem","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Katz","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ann","family":"MacDonald","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Mazzulli","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Poutanen","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Simor","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Mubareka","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Patel","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Sales","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Walmsley","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christie","family":"Vermeiren","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Yamamura","sequence":"additional","affiliation":[{"name":"for the Toronto Invasive Bacterial Diseases Network"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"11","key":"zoi250154r1","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases.","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"zoi250154r2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1056\/NEJM198907063210101","article-title":"Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A.","volume":"321","author":"Stevens","year":"1989","journal-title":"N Engl J Med"},{"issue":"9","key":"zoi250154r3","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.3201\/eid2809.212129","article-title":"Increasing incidence of invasive group A Streptococcus disease, Idaho, USA, 2008-2019.","volume":"28","author":"Dunne","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"zoi250154r4","doi-asserted-by":"publisher","DOI":"10.33321\/cdi.2019.43.8","article-title":"Recent trends in invasive group A Streptococcus disease in Victoria.","volume":"43","author":"Oliver","year":"2019","journal-title":"Commun Dis Intell (2018)"},{"issue":"2","key":"zoi250154r5","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/S1473-3099(17)30693-X","article-title":"Resurgence of scarlet fever in England, 2014-16: a population-based surveillance study.","volume":"18","author":"Lamagni","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"zoi250154r6","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1016\/S1473-3099(19)30446-3","article-title":"Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study.","volume":"19","author":"Lynskey","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"zoi250154r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2023.100873","article-title":"Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges.","volume":"41","author":"Abo","year":"2023","journal-title":"Lancet Reg Health West Pac"},{"issue":"1","key":"zoi250154r8","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13613-024-01249-7","article-title":"Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series.","volume":"14","author":"Peetermans","year":"2024","journal-title":"Ann Intensive Care"},{"issue":"20","key":"zoi250154r9","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1001\/jama.2023.5927","article-title":"Group A streptococcal meningitis with the M1UK variant in the Netherlands.","volume":"329","author":"van der Putten","year":"2023","journal-title":"JAMA"},{"issue":"10","key":"zoi250154r10","doi-asserted-by":"publisher","first-page":"265","DOI":"10.15585\/mmwr.mm7210a4","article-title":"Notes from the field: increase in pediatric invasive group A Streptococcus infections\u2014Colorado and Minnesota, October-December 2022.","volume":"72","author":"Barnes","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"7","key":"zoi250154r12","doi-asserted-by":"publisher","first-page":"946.e5","DOI":"10.1016\/j.cmi.2020.02.026","article-title":"Updated emm-typing protocol for Streptococcus pyogenes.","volume":"26","author":"Frost","year":"2020","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"zoi250154r13","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.1128\/JCM.43.4.1678-1683.2005","article-title":"Invasive group A streptococcal disease in Alberta, Canada (2000 to 2002).","volume":"43","author":"Tyrrell","year":"2005","journal-title":"J Clin Microbiol"},{"issue":"5","key":"zoi250154r14","doi-asserted-by":"publisher","first-page":"135","DOI":"10.14745\/ccdr.v50i05a03","article-title":"Invasive group A streptococcal disease surveillance in Canada, 2021-2022.","volume":"50","author":"Golden","year":"2024","journal-title":"Can Commun Dis Rep"},{"issue":"2","key":"zoi250154r17","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1093\/cid\/civ803","article-title":"Invasive pneumococcal disease among immunocompromised persons: implications for vaccination programs.","volume":"62","author":"Shigayeva","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"1","key":"zoi250154r18","doi-asserted-by":"publisher","first-page":"136","DOI":"10.23907\/2018.010","article-title":"The shock of strep: rapid deaths due to group A Streptococcus.","volume":"8","author":"Thompson","year":"2018","journal-title":"Acad Forensic Pathol"},{"issue":"1","key":"zoi250154r21","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1038\/s41541-023-00730-x","article-title":"Update on the development of group A Streptococcus vaccines.","volume":"8","author":"Ajay Castro","year":"2023","journal-title":"NPJ Vaccines"},{"issue":"3","key":"zoi250154r22","doi-asserted-by":"publisher","first-page":"272","DOI":"10.3390\/vaccines12030272","article-title":"Recent scientific advancements towards a vaccine against group A Streptococcus.","volume":"12","author":"Fan","year":"2024","journal-title":"Vaccines (Basel)"},{"issue":"4","key":"zoi250154r23","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.1097\/INF.0000000000003810","article-title":"Increase in invasive group A Streptococcal infections in children in the Netherlands, a survey among 7 hospitals in 2022.","volume":"42","author":"van Kempen","year":"2023","journal-title":"Pediatr Infect Dis J"},{"issue":"1","key":"zoi250154r24","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200942","article-title":"Increase in invasive group A streptococcal infection notifications, England, 2022.","volume":"28","author":"Guy","year":"2023","journal-title":"Euro Surveill"},{"issue":"1","key":"zoi250154r25","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200941","article-title":"Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022.","volume":"28","author":"de Gier","year":"2023","journal-title":"Euro Surveill"},{"issue":"10","key":"zoi250154r26","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/jpids\/piad080","article-title":"Outbreak of invasive group A Streptococcus in children\u2014Colorado, October 2022-April 2023.","volume":"12","author":"Ho","year":"2023","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"12","key":"zoi250154r27","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1093\/cid\/cir726","article-title":"Invasive bacterial infections in relation to influenza outbreaks, 2006-2010.","volume":"53","author":"Tasher","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"3","key":"zoi250154r28","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1093\/cid\/ciad197","article-title":"Increases in group A streptococcal infections in the pediatric population in Houston, TX, 2022.","volume":"77","author":"Aboulhosn","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"11","key":"zoi250154r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2024.102545","article-title":"Post-pandemic increase in invasive group A strep infections in New Zealand.","volume":"17","author":"Ammar","year":"2024","journal-title":"J Infect Public Health"},{"issue":"10","key":"zoi250154r30","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00766-24","article-title":"Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive Streptococcus pyogenes 2009-2023, the Netherlands: a molecular epidemiological study.","volume":"62","author":"R\u00fcmke","year":"2024","journal-title":"J Clin Microbiol"},{"issue":"2","key":"zoi250154r31","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1093\/cid\/ciac720","article-title":"Should linezolid replace clindamycin as the adjunctive antimicrobial of choice in group A streptococcal necrotizing soft tissue infection and toxic shock syndrome: a focused debate.","volume":"76","author":"Cort\u00e9s-Penfield","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"9","key":"zoi250154r32","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1016\/S1473-3099(21)00456-4","article-title":"Increasing clindamycin resistance in group A Streptococcus.","volume":"21","author":"White","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"zoi250154r33","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.1093\/cid\/ciab575","article-title":"Patterns of antibiotic nonsusceptibility among invasive group A Streptococcus infections\u2014United States, 2006-2017.","volume":"73","author":"Fay","year":"2021","journal-title":"Clin Infect Dis"},{"issue":"17","key":"zoi250154r34","doi-asserted-by":"publisher","first-page":"E1768","DOI":"10.1073\/pnas.1403138111","article-title":"Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences.","volume":"111","author":"Nasser","year":"2014","journal-title":"Proc Natl Acad Sci U S A"},{"key":"zoi250154r35","doi-asserted-by":"publisher","DOI":"10.1099\/mgen.0.000994","article-title":"Characterization of emergent toxigenic M1UK? Streptococcus pyogenes and associated sublineages.","author":"Li","year":"2023","journal-title":"Microb Genom"},{"issue":"7","key":"zoi250154r36","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1007\/s10096-021-04167-9","article-title":"The impact of pneumococcal conjugate vaccine-13 on the incidence of pediatric community-acquired bacteremia.","volume":"40","author":"Dabaja-Younis","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"7","key":"zoi250154r37","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/j.cmi.2018.10.020","article-title":"Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions\/empyema in Germany, 2010-2017: a nationwide surveillance study.","volume":"25","author":"Liese","year":"2019","journal-title":"Clin Microbiol Infect"},{"issue":"2","key":"zoi250154r38","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1093\/jpids\/piz013","article-title":"Invasive group A Streptococcus infection in children in Southern Israel before and after the introduction of Varicella vaccine.","volume":"9","author":"Hasin","year":"2020","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"1","key":"zoi250154r39","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0000010","article-title":"Differences between Belgian and Brazilian group A Streptococcus epidemiologic landscape.","volume":"1","author":"Smeesters","year":"2006","journal-title":"PLoS One"},{"issue":"10","key":"zoi250154r40","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/S1473-3099(09)70178-1","article-title":"Global emm type distribution of group A streptococci: systematic review and implications for vaccine development.","volume":"9","author":"Steer","year":"2009","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"zoi250154r41","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1177\/10935266211064696","article-title":"Fatal pediatric streptococcal infection: a clinico-pathological study.","volume":"25","author":"Nagy","year":"2022","journal-title":"Pediatr Dev Pathol"},{"key":"zoi250154r11","unstructured":"World Health Organization. Increased incidence of scarlet fever and invasive Group A Streptococcus infection\u2014multi-country. News release. December 15, 2022. Accessed July 19, 2024. https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON429"},{"key":"zoi250154r15","unstructured":"CLSI - Clinical and Laboratory Standards Institute. Accessed July 19, 2024. https:\/\/clsi.org\/"},{"key":"zoi250154r16","unstructured":"Government of Canada. National case definition: invasive group A streptococcal disease. Updated May 2008. Accessed December 11, 2024. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/group-a-streptococcal-diseases\/health-professionals\/national-case-definition.html"},{"key":"zoi250154r19","unstructured":"Statistics Canada. Canada\u2019s national statistical agency. Accessed July 19, 2024. https:\/\/www.statcan.gc.ca\/en\/start"},{"key":"zoi250154r20","unstructured":"OpenEpi Menu. Accessed July 19, 2024. https:\/\/www.openepi.com\/Menu\/OE_Menu.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2832049\/dabajayounis_2025_oi_250154_1742576192.73568.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T23:53:27Z","timestamp":1743724407000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2832049"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.2861","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}