{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:49:34Z","timestamp":1787010574849,"version":"build-2736575974"},"reference-count":33,"publisher":"Microbiology Society","issue":"6","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:p>\n                    Invasive group A streptococcal (iGAS) disease cases increased in the first half of 2022 in the Netherlands, with a remarkably high proportion of\n                    <jats:italic>emm<\/jats:italic>\n                    4 isolates. Whole-genome sequence analysis of 66\n                    <jats:italic>emm<\/jats:italic>\n                    4 isolates, 40 isolates from the pre-coronavirus disease 2019 (COVID-19) pandemic period 2009\u20132019 and 26 contemporary isolates from 2022, identified a novel\n                    <jats:italic>\n                      <jats:named-content content-type=\"species\">\n                        <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/doi.org\/10.1601\/nm.5606\" xlink:type=\"simple\">Streptococcus pyogenes<\/jats:ext-link>\n                      <\/jats:named-content>\n                    <\/jats:italic>\n                    lineage (M4\n                    <jats:sub>NL22<\/jats:sub>\n                    ), which accounted for 85\u200a% of\n                    <jats:italic>emm<\/jats:italic>\n                    4 iGAS cases in 2022. Surprisingly, we detected few isolates of the\n                    <jats:italic>emm<\/jats:italic>\n                    4 hypervirulent clone, which has replaced nearly all other\n                    <jats:italic>emm<\/jats:italic>\n                    4 in the USA and the UK. M4\n                    <jats:sub>NL22<\/jats:sub>\n                    displayed genetic differences compared to other\n                    <jats:italic>emm<\/jats:italic>\n                    4 strains, although these were of unclear biological significance. In publicly available data, we identified a single Norwegian isolate belonging to M4\n                    <jats:sub>NL22<\/jats:sub>\n                    , which was sampled after the isolates from this study, possibly suggesting export of M4\n                    <jats:sub>NL22<\/jats:sub>\n                    to Norway. In conclusion, our study identified a novel\n                    <jats:italic>S. pyogenes emm<\/jats:italic>\n                    4 lineage underlying an increase of iGAS disease in early 2022 in the Netherlands and the results have been promptly communicated to public health officials.\n                  <\/jats:p>","DOI":"10.1099\/mgen.0.001026","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T10:17:59Z","timestamp":1685614679000},"source":"Crossref","is-referenced-by-count":16,"title":["Novel emm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022"],"prefix":"10.1099","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7916-6665","authenticated-orcid":false,"given":"Boas C.L.","family":"van der Putten","sequence":"first","affiliation":[{"name":"Present address: National Institute for Public Health and the Environment, Bilthoven, Netherlands"},{"name":"Department of Medical Microbiology and Infection Prevention, Amsterdam UMCs location University of Amsterdam, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy C.M.","family":"Bril-Keijzers","sequence":"additional","affiliation":[{"name":"Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMCs location AMC, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidewij W.","family":"Rumke","sequence":"additional","affiliation":[{"name":"Medical Microbiology, UMC Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7265-8886","authenticated-orcid":false,"given":"Stefan M.T.","family":"Vestjens","sequence":"additional","affiliation":[{"name":"Medical Microbiology, UMC Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda 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