{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T21:05:16Z","timestamp":1770757516300,"version":"3.50.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Both invasive group A streptococcal (iGAS) infections and the number of persons experiencing homelessness (PEH) are increasing. Protection of PEH from the burden of iGAS infections requires understanding of its epidemiology.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess whether the resurgence of iGAS infections after the COVID-19 pandemic included PEH.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This cross-sectional study of population-based iGAS surveillance used Canada\u2019s National Microbiology Laboratory for\n emm<\/jats:italic>\n typing and Statistics Canada and point-in-time counts to identify denominators. Participants included 503 persons with iGAS infections from January 1, 2022, to December 31, 2023, in the Toronto and Peel Region, Canada (population, 4.5 million).\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The main outcome was disease incidence among PEH over time and compared with housed persons. Secondary outcomes were differences in risk factors, presentation, disease severity, and infecting\n emm<\/jats:italic>\n types between PEH and housed persons.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Ninety iGAS cases occurred among PEH (median age, 47.0 years [IQR, 37.7-59.5 years]; 66 men [73.3%]) and 413 occurred among housed adults (median age, 58.9 years [IQR, 42.1-73.3 years]; 259 men [62.7%]). iGAS incidence among PEH increased from 270.4 (95% CI, 184.5-383.2) per 100\u202f000 per year in 2022 to 451.2 (95% CI, 348.2-575.7) per 100\u202f000 per year in 2023 (incidence rate ratio [IRR], 1.67; 95% CI, 1.06-2.69), not significantly different than the increase from 3.4 to 7.0 per 100\u202f000 per year among housed persons (IRR, 2.05; 95% CI, 1.67-2.52). iGAS incidence overall was 70.7-fold higher (95% CI, 56.3-fold to 88.7-fold) among PEH than housed persons. Compared with housed adults, PEH were less likely to be immunocompromised (adjusted odds ratio [AOR], 0.29; 95% CI, 0.11-0.73) and were more likely to be persons who inject drugs (AOR, 5.06; 95% CI, 2.79-9.19), to have nonintact skin (AOR, 4.16; 95% CI, 2.45-7.04), and to have iGAS presenting as soft tissue infection (AOR, 1.64; 95% CI, 1.02-2.64). PEH were less likely to die of iGAS than housed adults (AOR, 0.33; 95% CI, 0.12-0.95). Overall,\n emm<\/jats:italic>\n 1 and\n emm<\/jats:italic>\n 12 caused 33.7% of iGAS cases (137 of 406) among housed persons, but only 2.2% (2 of 90) among PEH; in contrast, isolates with\n emm<\/jats:italic>\n types 49, 74, 80, 82, and 92 caused 77.8% of iGAS cases (70 of 90) among PEH, but only 34.2% (139 of 406) among housed persons (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The\n emm<\/jats:italic>\n types frequently causing iGAS infections among PEH also caused iGAS infections among housed persons and were too highly clonal to assess transmission risk.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, the post\u2013COVID-19 pandemic resurgence of iGAS infections occurred among both PEH and housed adults, although the incidence among PEH was 70.7-fold greater. Risk factors, clinical presentations, outcomes, and infecting strains were very different. Improved iGAS protection for PEH, such as vaccines, is needed.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.57932","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:00:20Z","timestamp":1770739220000},"page":"e2557932","source":"Crossref","is-referenced-by-count":0,"title":["Invasive Group A Streptococcal Disease in Persons Experiencing Postpandemic Homelessness in Canada"],"prefix":"10.1001","volume":"9","author":[{"given":"Caroline","family":"Kassee","sequence":"first","affiliation":[{"name":"Department of Microbiology, Sinai Health, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halima","family":"Dabaja-Younis","sequence":"additional","affiliation":[{"name":"Infection Prevention and Control Unit, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucie","family":"Richard","sequence":"additional","affiliation":[{"name":"MAP Centre 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