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We investigated the molecular epidemiology of M1\n                      <jats:sub>UK<\/jats:sub>\n                      type strains and evaluated their clinical associations among adults with invasive group A\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      (iGAS) infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a nationwide multicenter surveillance study of iGAS infections from December 2023 to March 2025. Molecular typing, profiling of M1\n                      <jats:sub>UK<\/jats:sub>\n                      -associated single-nucleotide polymorphisms (SNPs) in the\n                      <jats:italic>rofA<\/jats:italic>\n                      ,\n                      <jats:italic>gldA<\/jats:italic>\n                      , and\n                      <jats:italic>pstB<\/jats:italic>\n                      regions, and\n                      <jats:italic>emm<\/jats:italic>\n                      -cluster assignment were performed. Adult clinical characteristics and outcomes were compared between M1\n                      <jats:sub>UK<\/jats:sub>\n                      type and non-M1 type infections after exclusion of the single adult M1\n                      <jats:sub>global<\/jats:sub>\n                      case.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 155 patients in the molecular epidemiology cohort, M1\n                      <jats:sub>UK<\/jats:sub>\n                      type strains accounted for 58 isolates, whereas only one M1\n                      <jats:sub>global<\/jats:sub>\n                      isolate was identified. Historical analysis showed that M1\n                      <jats:sub>global<\/jats:sub>\n                      predominated among isolates collected in the early 2010s, whereas M1\n                      <jats:sub>UK<\/jats:sub>\n                      type strains were detected mainly in recent periods. In adult clinical comparisons, M1\n                      <jats:sub>UK<\/jats:sub>\n                      type infection was associated with streptococcal toxic shock syndrome (STSS;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and necrotizing fasciitis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable analysis, younger age, necrotizing fasciitis, and serum creatinine\u2009\u2265\u20092.0\u00a0mg\/dL were associated with M1\n                      <jats:sub>UK<\/jats:sub>\n                      type infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      M1\n                      <jats:sub>UK<\/jats:sub>\n                      type strains were important contributors to contemporary iGAS infections in Japan and were associated with severe clinical presentations, supporting sustained molecular surveillance beyond conventional\n                      <jats:italic>emm<\/jats:italic>\n                      typing.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10096-026-05649-4","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:55:57Z","timestamp":1788162957000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predominance of M1UK type strains and their clinical associations in invasive Streptococcus pyogenes infections in Japan, 2023\u20132025"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8435-4425","authenticated-orcid":false,"given":"Shigeo","family":"Hanada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misako","family":"Takata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyuki","family":"Baba-Morozumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Iwata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimiko","family":"Ubukata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"5649_CR1","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1097\/QCO.0000000000001064","volume":"37","author":"K Davis","year":"2024","unstructured":"Davis K, Abo YN, Steer AC, Osowicki J (2024) Chains of misery: surging invasive group A streptococcal disease. 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