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Horizontal transfer of mobile genetic elements has played a central role in the evolution of the M1T1 clone<jats:sup>4,5<\/jats:sup>, with bacteriophage-encoded determinants DNase Sda1<jats:sup>6<\/jats:sup> and superantigen SpeA2<jats:sup>7<\/jats:sup> contributing to enhanced virulence and colonization respectively. Outbreaks of scarlet fever in Hong Kong and China in 2011, caused primarily by <jats:italic>emm<\/jats:italic>12 GAS<jats:sup>8,9,10<\/jats:sup>, led to our investigation of the next most common cause of scarlet fever, <jats:italic>emm<\/jats:italic>1 GAS<jats:sup>8,9<\/jats:sup>. Genomic analysis of 18 <jats:italic>emm<\/jats:italic>1 isolates from Hong Kong and 16 <jats:italic>emm<\/jats:italic>1 isolates from mainland China revealed the presence of mobile genetic elements associated with the expansion of <jats:italic>emm<\/jats:italic>12 scarlet fever clones<jats:sup>10,11<\/jats:sup> in the M1T1 genomic background. These mobile genetic elements confer expression of superantigens SSA and SpeC and resistance to tetracycline, erythromycin and clindamycin. Horizontal transfer of mobile DNA conferring multi-drug resistance and expression of a new superantigen repertoire in the M1T1 clone should trigger heightened public health awareness for the global dissemination of these genetic elements.<\/jats:p>","DOI":"10.1038\/srep15877","type":"journal-article","created":{"date-parts":[[2015,11,2]],"date-time":"2015-11-02T10:35:45Z","timestamp":1446460545000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Transfer of scarlet fever-associated elements into the group A Streptococcus M1T1 clone"],"prefix":"10.1038","volume":"5","author":[{"given":"Nouri L.","family":"Ben Zakour","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhai","family":"You","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H. 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