Increase of emm1 isolates among group A Streptococcus strains causing scarlet fever in Shanghai, China. (September 2020) - Chen, Mingliang
Highlights: Remarkable increase of emm 1 proportion in GAS population. Continuous data of ongoing scarlet fever outbreaks in China. Average GAS carriage rate of 7.6% in school-aged children. Characteristic mobile genetic elements harboured by Chinese emm 1 isolates. Abstract: Objective: Scarlet fever epidemics caused by group A Streptococcus (GAS) have been ongoing in China since 2011. However, limited data are available on the dynamic molecular characterizations of the epidemic strains. Method: Epidemiological data of scarlet fever in Shanghai were obtained from the National Notifiable Infectious Disease Surveillance System. Throat swabs of patients with scarlet fever and asymptomatic school-age children were cultured. Illumina sequencing was performed on 39 emm 1 isolates. Results: The annual incidence of scarlet fever was 7.5–19.4/100, 000 persons in Shanghai during 2011–2015, with an average GAS carriage rate being 7.6% in school-age children. The proportion of emm 1 GAS strains increased from 3.8% in 2011 to 48.6% in 2014; they harbored a superantigen profile similar to emm 12 isolates, except for the speA gene. Two predominant clones, SH001- emm 12, and SH002- emm 1, circulated in 66.9% of scarlet fever cases and 44.8% of carriers. Genomic analysis showed emm 1 isolates throughout China constituted distinct clades, enriched by the presence of mobile genetic elements carrying the multidrug-resistant determinants ermB and tetM and virulence genes speA, speC, and spd1 . Conclusion: A significant increase in the proportion of emm 1 strains occurred in the GAS population, causing scarlet fever in China. Ongoing surveillance is warranted to monitor the dynamic changes of GAS clones.