The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study.
The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study.
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DOI：
10.1016/j.cmi.2023.03.001
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发表时间：
2023-07
影响因子：
14.2
通讯作者：
Edgeworth, Jonathan D.
中科院分区：
文献类型：
--
作者：
Alcolea-Medina, Adela;Snell, Luke B.;Alder, Christopher;Charalampous, Themoula;Tan, Mark K. I.;Al-Yaakoubi, Noor;Humayun, Gul;Newsholme, William;Goldenberg, Simon;Nebbia, Gaia;Neil, Stuart J. D.;Batra, Rahul;Edgeworth, Jonathan D.
伦敦（英国）正在发生的化脓性链球菌（A组链球菌）暴发的流行病学和全基因组测序分析。2022年11月27日至12月10日期间，从服务于伦敦中部和南部的诊断实验室前瞻性识别A组链球菌病例。审查病例记录并检索分离株。病例数与前5年进行了比较。全基因组测序采用长读段纳米孔技术进行emm分型和超抗原基因鉴定。通过单变量和多变量logistic回归分析评估病原体相关因素与侵袭性疾病的关系。病例数从2022年10月开始从每天2. 0例的基线增加，到2022年12月，平均每天病例数达到每天10. 8例，是冬季通常病例数的四倍。在前瞻性研究期间共确定了113例病例。四分之三（86/113，76%）为儿科病例，包括2例死亡。113例中，11例（10%）为侵袭性。总共有56株分离株成功测序，包括11株侵袭性分离株中的10株（91%）。emm 12型（33/56，59%）和emm 1型（9/56，16%）占优势，9株emm 1型中有7株（78%）来自M1 uk克隆。大多数侵袭性分离株具有超抗原基因spea（7/10，70%）和spej（8/10，80%），而在非侵袭性分离株中，这些超抗原基因较少被发现（spea：5/46，11%和spej：7/46，15%）。通过对病原体相关因素的多变量分析，spea（OR 8.9，CI 1.4-57，p 0.020）和spej（OR 12，CI 1.8-78，p 0.011）与侵袭性疾病相关。emm 12和emm 1型在目前的疫情中占主导地位，主要影响儿童。在这次疫情中，spea和spej超抗原基因与呈现的严重程度相关。
Epidemiological and whole-genome sequencing analysis of an ongoing outbreak of Streptococcus pyogenes (Group A Streptococcus) in London (United Kingdom). Prospective identification of Group A Streptococcus cases from a diagnostic laboratory serving central and south London between 27 November and 10 December 2022. Case notes were reviewed and isolates were retrieved. Case numbers were compared with the previous 5 years. Whole-genome sequencing was performed with long-read, nanopore technology for emm typing and identification of superantigen genes. Associations of pathogen-related factors with an invasive disease were assessed by single-variable and multi-variable logistic regression. Case numbers began increasing in October 2022 from a baseline of 2.0 cases per day, and in December 2022, the average daily case numbers reached 10.8 cases per day, four-fold the number usually seen in winter. A total of 113 cases were identified during the prospective study period. Three quarters (86/113, 76%) were paediatric cases, including 2 deaths. Of 113 cases, 11 (10%) were invasive. In total, 56 isolates were successfully sequenced, including 10 of 11 (91%) invasive isolates. The emm12 (33/56, 59%) and emm1 (9/56, 16%) types were predominant, with 7 of 9 (78%) emm1 isolates being from the M1uk clone. The majority of invasive isolates had superantigen genes spea (7/10, 70%) and spej (8/10, 80%), whereas, in non-invasive isolates, these superantigen genes were found less frequently (spea: 5/46, 11% and spej: 7/46, 15%). By multivariable analysis of pathogen-related factors, spea (OR 8.9, CI 1.4–57, p 0.020) and spej (OR 12, CI 1.8–78, p 0.011) were associated with invasive disease. emm12 and emm1 types predominate in the ongoing outbreak, which mainly affects children. In this outbreak, the spea and spej superantigen genes are associated with the severity of presentation.
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