Increase in scarlet fever notifications in the United Kingdom, 2013/2014

Increases in scarlet fever above usual seasonal levels are currently being seen across the United Kingdom. Medical practitioners have been alerted to the exceptional increase in incidence. Given the potential for this to signal a population increase in invasive group A streptococcal disease, close monitoring of invasive disease is essential.

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European surveillance of severe group A streptococcal disease

Weekly releases (1997–2007) ◽

10.2807/esw.06.35.01870-en ◽

2002 ◽

Vol 6 (35) ◽

Cited By ~ 2

Author(s):

C Schalén ◽

Collective Strep-EURO

Keyword(s):

Public Health ◽

United Kingdom ◽

Czech Republic ◽

Invasive Disease ◽

The Czech Republic ◽

Surveillance Programme ◽

Streptococcal Disease ◽

The United Kingdom ◽

Severe Group ◽

Group A

Strep-EURO, a new European Commission Framework Five (QLK2-CT-2002-01398) surveillance programme for severe group A streptococcal disease (GAS), will be launched on 1 September 2002. The aim of the programme is to enhance understanding of the epidemiology of GAS invasive disease in Europe. Public health institutes from Sweden, Germany, the United Kingdom, the Czech Republic, Greece, Italy, Finland, Denmark, Romania, and Cyprus will participate.

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Emergence of a New Highly Successful Acapsular Group A Streptococcus Clade of Genotype emm89 in the United Kingdom

mBio ◽

10.1128/mbio.00622-15 ◽

2015 ◽

Vol 6 (4) ◽

Cited By ~ 75

Author(s):

Claire E. Turner ◽

James Abbott ◽

Theresa Lamagni ◽

Matthew T. G. Holden ◽

Sophia David ◽

...

Keyword(s):

United Kingdom ◽

Hyaluronic Acid ◽

Genome Sequencing ◽

Virulence Factors ◽

Invasive Disease ◽

Whole Genome ◽

The United Kingdom ◽

Streptolysin O ◽

Group A ◽

Hyaluronic Acid Capsule

ABSTRACTGroup AStreptococcus(GAS) genotypeemm89 is increasingly recognized as a leading cause of disease worldwide, yet factors that underlie the success of thisemmtype are unknown. Surveillance identified a sustained nationwide increase inemm89 invasive GAS disease in the United Kingdom, prompting longitudinal investigation of this genotype. Whole-genome sequencing revealed a recent dramatic shift in theemm89 population with the emergence of a new clade that increased to dominance over previousemm89 variants. Temporal analysis indicated that the clade arose in the early 1990s but abruptly increased in prevalence in 2008, coinciding with an increased incidence ofemm89 infections. Although standard variable typing regions (emmsubtype,teetype,softype, and multilocus sequence typing [MLST]) remained unchanged, uniquely the emergent clade had undergone six distinct regions of homologous recombination across the genome compared to the rest of the sequencedemm89 population. Two of these regions affected known virulence factors, the hyaluronic acid capsule and the toxins NADase and streptolysin O. Unexpectedly, and in contrast to the rest of the sequencedemm89 population, the emergent clade-associated strains were genetically acapsular, rendering them unable to produce the hyaluronic acid capsule. The emergent clade-associated strains had also acquired an NADase/streptolysin O locus nearly identical to that found inemm12 and modernemm1 strains but different from the rest of the sequencedemm89 population. The emergent clade-associated strains had enhanced expression of NADase and streptolysin O. The genome remodeling in the new clade variant and the resultant altered phenotype appear to have conferred a selective advantage over otheremm89 variants and may explain the changes observed inemm89 GAS epidemiology.IMPORTANCESudden upsurges or epidemic waves are common features of group A streptococcal disease. Although the mechanisms behind such changes are largely unknown, they are often associated with an expansion of a single genotype within the population. Using whole-genome sequencing, we investigated a nationwide increase in invasive disease caused by the genotypeemm89 in the United Kingdom. We identified a new clade variant that had recently emerged in theemm89 population after having undergone several core genomic recombination-related changes, two of which affected known virulence factors. An unusual finding of the new variant was the loss of the hyaluronic acid capsule, previously thought to be essential for causing invasive disease. A further genomic adaptation in the NADase/streptolysin O locus resulted in enhanced production of these toxins. Recombination-related genome remodeling is clearly an important mechanism in group AStreptococcusthat can give rise to more successful and potentially more pathogenic variants.

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Surveillance of systemic invasive disease caused by group A Streptococcus in Italy 1994-1996

Eurosurveillance ◽

10.2807/esm.03.02.00117-en ◽

1998 ◽

Vol 3 (2) ◽

pp. 11-4 ◽

Cited By ~ 5

Author(s):

B Suligoi ◽

C Von Hunolstein ◽

G Orefici ◽

F Scopetti ◽

M Pataracchia ◽

...

Keyword(s):

United Kingdom ◽

Surveillance System ◽

Group A Streptococcus ◽

Invasive Disease ◽

Haemolytic Streptococcus ◽

The United Kingdom ◽

Group A ◽

Set Up

In late May 1994, following reports of an outbreak of group A beta-haemolytic streptococcus (GAS) in the United Kingdom, the Istituto Superiore di Sanità (ISS) set up a surveillance system for systemic invasive GAS disease. The surveillance system was als

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Invasive Group A Streptococcal Disease in The Netherlands: Evidence for a Protective Role of Anti–Exotoxin A Antibodies

The Journal of Infectious Diseases ◽

10.1086/315222 ◽

2000 ◽

Vol 181 (2) ◽

pp. 631-638 ◽

Cited By ~ 33

Author(s):

Ellen M. Mascini ◽

Margriet Jansze ◽

Joop F. P. Schellekens ◽

James M. Musser ◽

Joop A. J. Faber ◽

...

Keyword(s):

The Netherlands ◽

Protective Role ◽

Exotoxin A ◽

Invasive Group ◽

Streptococcal Disease ◽

Group A

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P159 Invasive group A streptococcal disease in the UK, 2008–2012 and molecular characterisation of isolates during enhanced surveillance

International Journal of Antimicrobial Agents ◽

10.1016/s0924-8579(13)70402-3 ◽

2013 ◽

Vol 42 ◽

pp. S92 ◽

Cited By ~ 1

Author(s):

A. De Zoysa ◽

J. Coelho ◽

R. Daniel ◽

C. Dhami ◽

G. Kafatos ◽

...

Keyword(s):

Molecular Characterisation ◽

Invasive Group ◽

Streptococcal Disease ◽

Group A ◽

The Uk

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Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

Journal of Clinical Microbiology ◽

10.1128/jcm.02122-15 ◽

2015 ◽

Vol 54 (1) ◽

pp. 134-141 ◽

Cited By ~ 20

Author(s):

Karen Rudolph ◽

Michael G. Bruce ◽

Dana Bruden ◽

Tammy Zulz ◽

Alisa Reasonover ◽

...

Keyword(s):

Vaccine Development ◽

Case Fatality ◽

Invasive Disease ◽

Population Based ◽

The Arctic ◽

Surveillance Program ◽

Bacterial Disease ◽

Invasive Group ◽

Laboratory Surveillance ◽

Group A

The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n= 8), 5.8% (n= 20), and 1.2% (n= 4) of the isolates, respectively. A total of 51emmtypes were identified, of whichemm1 (11.1%) was the most prevalent, followed byemm82 (8.8%),emm49 (7.8%),emm12 andemm3 (6.6% each),emm89 (6.2%),emm108 (5.5%),emm28 (4.7%),emm92 (4%), andemm41 (3.8%). The five most commonemmtypes accounted for 41% of isolates. Theemmtypes in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.

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Stress in General Medical Practitioners of the United Kingdom

Stress and Tension Control 3 ◽

10.1007/978-1-4615-7915-1_12 ◽

1989 ◽

pp. 105-118

Author(s):

A. M. D. Porter ◽

J. G. R. Howie ◽

J. F. Forbes

Keyword(s):

United Kingdom ◽

Medical Practitioners ◽

The United Kingdom ◽

General Medical Practitioners

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High burden of invasive group A streptococcal disease in the Northern Territory of Australia

Epidemiology and Infection ◽

10.1017/s0950268815002010 ◽

2015 ◽

Vol 144 (5) ◽

pp. 1018-1027 ◽

Cited By ~ 21

Author(s):

R. BOYD ◽

M. PATEL ◽

B. J. CURRIE ◽

D. C. HOLT ◽

T. HARRIS ◽

...

Keyword(s):

Indigenous Population ◽

Case Series ◽

Northern Territory ◽

Molecular Characteristics ◽

Streptococcal Toxic Shock Syndrome ◽

Public Health Response ◽

Diverse Range ◽

Invasive Group ◽

Streptococcal Disease ◽

Group A

SUMMARYAlthough the incidence of invasive group A streptococcal disease in northern Australia is very high, little is known of the regional epidemiology and molecular characteristics. We conducted a case series of Northern Territory residents reported between 2011 and 2013 withStreptococcus pyogenesisolates from a normally sterile site. Of the 128 reported episodes, the incidence was disproportionately high in the Indigenous population at 69·7/100 000 compared to 8·8/100 000 in the non-Indigenous population. Novel to the Northern Territory is the extremely high incidence in haemodialysis patients of 2205·9/100 000 population; and for whom targeted infection control measures could prevent transmission. The incidences in the tropical north and semi-arid Central Australian regions were similar. Case fatality was 8% (10/128) and streptococcal toxic shock syndrome occurred in 14 (11%) episodes. Molecular typing of 82 isolates identified 28emmtypes, of which 63 (77%) were represented by fouremmclusters. Typing confirmed transmission between infant twins. While the diverse range ofemmtypes presents a challenge for effective coverage by vaccine formulations, the limited number ofemmclusters raises optimism should cluster-specific cross-protection prove efficacious. Further studies are required to determine effectiveness of chemoprophylaxis for contacts and to inform public health response.

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