{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T07:43:19Z","timestamp":1792827799446,"version":"4.5.0"},"reference-count":73,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU funding within the NextGenerationEU-MUR M4C 2.I.1.3PNRR Extended Partnership initiative on Emerging Infectious Diseases","award":["PE00000007"],"award-info":[{"award-number":["PE00000007"]}]},{"name":"EU funding within the NextGenerationEU-MUR M4C 2.I.1.3PNRR Extended Partnership initiative on Emerging Infectious Diseases","award":["CUP I83C22001810007"],"award-info":[{"award-number":["CUP I83C22001810007"]}]},{"name":"INF-ACT Cascade Open Call 2023 (COC-1-2023-ISS-01)","award":["PE00000007"],"award-info":[{"award-number":["PE00000007"]}]},{"name":"INF-ACT Cascade Open Call 2023 (COC-1-2023-ISS-01)","award":["CUP I83C22001810007"],"award-info":[{"award-number":["CUP I83C22001810007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Streptococcus pyogenes (Group A Streptococcus, GAS) is a major human pathogen capable of causing infections ranging from mild pharyngitis and impetigo to severe invasive diseases such as bacteremia, necrotizing fasciitis, and streptococcal toxic shock syndrome (STSS). Historically, the incidence of GAS infections declined during the early antibiotic era but began rising again from the early 2000s, driven partly by the emergence of hyper-virulent strains such as emm1 and emm12. From 2005 onward, significant increases in GAS infections were reported globally, accompanied by rising antibiotic resistance, particularly to macrolides and tetracyclines. During the COVID-19 pandemic, widespread public health measures led to a sharp decline in GAS infections, including invasive cases, but this trend reversed dramatically in late 2022 and 2023, with surges exceeding pre-pandemic levels, notably in children. Recent data implicate factors such as \u201cimmunity debt,\u201d viral co-infections, and the spread of virulent clones like M1UK. Looking forward, continued surveillance of GAS epidemiology, virulence factors, and resistance patterns is critical. Moreover, the emergence of GAS isolates with reduced susceptibility to beta-lactams underscores the need for vigilance despite the absence of fully resistant strains. The development of an effective vaccine remains an urgent priority to reduce GAS disease burden and prevent severe outcomes. Future research should focus on vaccine development, molecular mechanisms of virulence, and strategies to curb antimicrobial resistance.<\/jats:p>","DOI":"10.3390\/microorganisms13081871","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T09:59:13Z","timestamp":1754906353000},"page":"1871","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Recent Changes in the Epidemiology of Group A Streptococcus Infections: Observations and Implications"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-2837","authenticated-orcid":false,"given":"Susanna","family":"Esposito","sequence":"first","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Masetti","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Calanca","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2","family":"Canducci","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Rasmi","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Fradusco","sequence":"additional","affiliation":[{"name":"Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3468-5568","authenticated-orcid":false,"given":"Nicola","family":"Principi","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"ref_1","unstructured":"Ferretti, J.J., Stevens, D.L., and Fischetti, V.A. 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