{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:19:04Z","timestamp":1792189144592,"version":"4.4.0"},"reference-count":31,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001704","name":"European Society of Clinical Microbiology and Infectious Diseases","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001704","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004854","name":"St. Antonius Ziekenhuis","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004854","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100019573","name":"Amsterdam UMC","doi-asserted-by":"crossref","award":["Innovation grant"],"award-info":[{"award-number":["Innovation grant"]}],"id":[{"id":"10.13039\/100019573","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003246","name":"Nederlandse Organisatie voor Wetenschappelijk Onderzoek","doi-asserted-by":"crossref","award":["09150181910001"],"award-info":[{"award-number":["09150181910001"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2024,10,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:sec>\n            <jats:title\/>\n            <jats:p>\n              Since 2022, many countries have reported an upsurge in invasive group A streptococcal (iGAS) infections. We explored whether changes in\n              <jats:italic>Streptococcus pyogenes<\/jats:italic>\n              carriage rates or emergence of strains with potentially altered virulence, such as\n              <jats:italic>emm<\/jats:italic>\n              1 variants M1\n              <jats:sub>UK<\/jats:sub>\n              and M1\n              <jats:sub>DK<\/jats:sub>\n              , contributed to the 2022\/2023 surge in the Netherlands. We determined\n              <jats:italic>emm<\/jats:italic>\n              (sub)type distribution for 2,698 invasive and 351\n              <jats:italic>S<\/jats:italic>\n              .\n              <jats:italic>pyogenes<\/jats:italic>\n              carriage isolates collected between January 2009 and March 2023. Genetic evolution of\n              <jats:italic>emm<\/jats:italic>\n              1 was analyzed by whole-genome sequencing of 497\n              <jats:italic>emm<\/jats:italic>\n              1 isolates. The nationwide iGAS upsurge coincided with a sharp increase of\n              <jats:italic>emm<\/jats:italic>\n              1.0 from 18% (18\/100) of invasive isolates in Q1 2022 to 58% (388\/670) in Q1 2023 (Fisher\u2019s exact test,\n              <jats:italic>P<\/jats:italic>\n              &lt; 0.0001). M1\n              <jats:sub>UK<\/jats:sub>\n              became dominant among invasive\n              <jats:italic>emm<\/jats:italic>\n              1 isolates in 2016 and further expanded from 72% in Q1 2022 to 96% in Q1 2023. Phylogenetic comparison revealed evolution and clonal expansion of four new M1\n              <jats:sub>UK<\/jats:sub>\n              clades in 2022\/2023. DNase Spd1 and superantigen SpeC were acquired in 9% (46\/497) of\n              <jats:italic>emm<\/jats:italic>\n              1 isolates.\n              <jats:italic>S. pyogenes<\/jats:italic>\n              carriage rates and\n              <jats:italic>emm<\/jats:italic>\n              1 proportions in carriage isolates remained stable during this surge, and the expansion of M1\n              <jats:sub>UK<\/jats:sub>\n              in iGAS was not reflected in carriage isolates. During the 2022\/2023 iGAS surge in the Netherlands, expansion of four new M1\n              <jats:sub>UK<\/jats:sub>\n              clades was observed among invasive isolates, but not carriage isolates, suggesting increased virulence and fitness of M1\n              <jats:sub>UK<\/jats:sub>\n              compared to contemporary M1 strains. The emergence of more virulent clades has important implications for public health strategies such as antibiotic prophylaxis for close contacts of iGAS patients.\n            <\/jats:p>\n            <jats:sec>\n              <jats:title>IMPORTANCE<\/jats:title>\n              <jats:p>\n                This study describes the molecular epidemiology of invasive group A streptococcal (iGAS) infections in the Netherlands based on &gt;3,000\n                <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                isolates from both asymptomatic carriers and iGAS patients collected before, during, and after the COVID-19 pandemic period (2009\u20132023) and is the first to assess whether changes in carriage rates or carried\n                <jats:italic>emm<\/jats:italic>\n                types contributed to the alarming post-COVID-19 upsurge in iGAS infections. We show that the 2022\/2023 iGAS surge coincided with a sharp increase of\n                <jats:italic>emm<\/jats:italic>\n                1, particularly the toxicogenic M1\n                <jats:sub>UK<\/jats:sub>\n                variant, in invasive isolates, but not in carriage isolates. These findings suggest that increased virulence and fitness of M1\n                <jats:sub>UK<\/jats:sub>\n                likely contributes to an increased dissemination between hosts. The emergence of a more virulent and fit lineage has important implications for iGAS control interventions such as antibiotic prophylaxis for close contacts of iGAS patients and calls for a reappraisal of iGAS control interventions and guidelines.\n              <\/jats:p>\n            <\/jats:sec>\n          <\/jats:sec>","DOI":"10.1128\/jcm.00766-24","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T13:00:32Z","timestamp":1724850032000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":48,"title":["Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive\n            <i>Streptococcus pyogenes<\/i>\n            2009\u20132023, the Netherlands: a molecular epidemiological study"],"prefix":"10.1128","volume":"62","author":[{"given":"Lidewij W.","family":"R\u00fcmke","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infection Prevention, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan M. T.","family":"Vestjens","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands"},{"name":"Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boas C. L.","family":"van der Putten","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy C. 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Disease Outbreak News; increased incidence of scarlet fever and invasive Group A Streptococcus infection - multi-country. Geneva: WHO. Available from: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON429. Retrieved 23 Aug 2023."},{"key":"e_1_3_5_5_2","unstructured":"Increase in Invasive Group A Strep Infections 2022\u20132023. CDC. Available from: https:\/\/archive.cdc.gov\/#\/details?q=igas-infections-investigation&start=0&rows=10&url=https:\/\/www.cdc.gov\/groupastrep\/igas-infections-investigation.html. 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CMI Comm 1:100004. doi:10.1016\/j.cmicom.2024.100004","DOI":"10.1016\/j.cmicom.2024.100004"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00766-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/jcm.00766-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T13:03:00Z","timestamp":1729083780000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/jcm.00766-24"}},"subtitle":[],"editor":[{"given":"Alexander","family":"Mellmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,10,16]]},"references-count":31,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,16]]}},"alternative-id":["10.1128\/jcm.00766-24"],"URL":"https:\/\/doi.org\/10.1128\/jcm.00766-24","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,16]]},"assertion":[{"value":"2024-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00766-24"}}