ArticleThe Lancet. Infectious diseases2019
Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study.
Article in The Lancet. Infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 137 papers, 2 of them syntheses that pooled it.
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137 citing papers in PubMed, 2 syntheses or guidelines pooled it, 240 citations in OpenAlex.
- Pooled it
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- Epidemiology and clinical characteristics of invasive group A streptococcal infection in the Republic of Korea, 2015-2024: a nationwide multicenter study.The Lancet regional health. Western Pacific · 2026Article
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- Emergence of distinct Streptococcus pyogenes emm1 and emm12 lineages in China.Nature microbiology · 2026Article
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- Acquisition of toxin-encoding lysogenic bacteriophage elements enhances the virulence of pandemicInfection and immunity · 2026Article
- Immune-adaptive pathogen variation reveals targetable mediators of gram-positive bacterial killing in macrophages.Science advances · 2026Article
- Group A Streptococcal Virulence Factors and Vaccine Development-An Update.Microorganisms · 2026Review
- Molecular epidemiology and antimicrobial susceptibility of group A Streptococcus isolated from children in Greece during 2023.Infection · 2026Article
- Cross-sectional hospital-based investigation on clinical characteristics of pediatric Group A Streptococcus isolates in a Beijing hospital from 2014 to 2023.Annals of clinical microbiology and antimicrobials · 2026Article
77 more citing papers are in PubMed but not listed here.
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Authors and funding
14 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundSince 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England's scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events.
methodsWe analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014-16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009-16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses.
findingsCoincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (p<0·0001). Sequences of emm1 isolates from 2009-16 showed emergence of a new emm1 lineage (designated M1
interpretationA dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1
fundingUK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.
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