{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:00:49Z","timestamp":1790071249791,"version":"4.0.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Broad Agency Announcement","award":["75D30122C15561"],"award-info":[{"award-number":["75D30122C15561"]}]},{"DOI":"10.13039\/100005239","name":"Indian Health Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005239","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>American Indian\/Alaska Native (AI\/AN) communities in the United States have high rates of group A streptococcal (GAS) infections. We determined the incidence of invasive infections in AI communities in the Southwest and compared emm types from invasive infections, pharyngitis, and throat carriage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Activities conducted in the White Mountain Apache Tribal lands (WMA) and Navajo Nation (NN) included active, laboratory-based surveillance for invasive GAS infections (WMA: 2019\u20132024; NN: 2023\u20132024; all ages); surveillance for GAS pharyngitis (2023\u20132024; children 0\u201317 years); and culture for GAS from oropharyngeal carriage samples (2019 and 2022\u20132023; children 0\u201314 years). Emm types were determined by whole-genome sequencing. Annual incidence rates were calculated using Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In WMA, age-standardized rates of invasive infections ranged from 80 to 270\/100 000 persons between 2019 and 2024. Predominant emm types varied (n = 74 isolates): 91 (59%) and 49 (32%) in 2019\u20132020 and 43 (40%) and 53 (30%) in 2023. In NN, rates were 40\u201360\/100 000 persons in 2023\u20132024; common emm types (n = 51) were 53 (28%), 101 (18%), and 12 (16%). In WMA and NN, emm types 1, 12, and 53 predominated in pharyngitis (n = 190) and 1, 12, and 91 in throat carriage (n = 119).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rates of invasive GAS infections in these communities were 3\u201335 times higher than the national US average (12.2\/100 000 in 2024). Emm types varied over time with limited overlap in strains from throat carriage or pharyngitis isolates and those from invasive infections. Findings support continuing GAS surveillance and engaging AI\/AN communities throughout vaccine development and evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiag462","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:19:23Z","timestamp":1788520763000},"source":"Crossref","is-referenced-by-count":0,"title":["Incidence of Invasive Group A Streptococcal Infections and Comparison of\n                    <i>Emm<\/i>\n                    Types From Invasive Infections, Pharyngitis, and Throat Carriage in American Indian Communities in the Southwest United States"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8512-8326","authenticated-orcid":false,"given":"Catherine G","family":"Sutcliffe","sequence":"first","affiliation":[{"name":"Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland 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