Distribution of emm types and macrolide resistance determinants among group A streptococci in the Middle East and North Africa region. (September 2020) - Rafei, Rayane
Highlights: Epidemiological data of Group A Streptococcus (GAS) are limited in the MENA region. emm1, 12, 89, 4, 28, and 3 were responsible for the major GAS burden in the MENA. The reported coverage rate of the 30-valent vaccine candidate ranged from 42–100%. High values of macrolide resistance rates up to 70% were recorded in the MENA. Abstract: Objectives: The aim of this review was to provide an updated scenario on the epidemiology of group A streptococci (GAS) in the Middle East and North Africa (MENA) region with a special spotlight on the most prevalent emm types and macrolide resistance profiles. Methods: This review briefly summarises the disease burden for GAS in the MENA region. Results: Whilst the burden of invasive GAS infections is difficult to assess in the MENA region, the GAS prevalence ranged from 2.5% up to 42.4% in pharyngitis patients and from 2.4% up to 35.4% in healthy carriers. emm1, emm12, emm89, emm4, emm28 and emm3 were responsible for the major GAS burden in the MENA region. The coverage rate of the new M protein-based vaccine candidate (30-valent) varied from 42% to 100% according to the country. The rate of erythromycin resistance differed substantially between countries from low to moderate or high. Conclusion: These data add more shreds of evidence on the neglected GAS burden in the MENA region. Systematic surveillance of invasive GAS infections along with molecular characterisation of GAS isolates are strongly recommended to track the trends of circulating clones and to evaluate the potential coverage of vaccine candidates.