A post-COVID-19 upsurge in Group A Streptococcus in the Czech Republic was driven by emm1 and emm12 with shared virulence factors

Abstract

BACKGROUND: In 2023, a significant increase in Streptococcus pyogenes, Group A Streptococcus (GAS) culture positivity was observed in Czech microbiological laboratories. We conducted a multicentre study to obtain epidemiological data and characterise circulating strains. METHODS: Eleven microbiology departments provided data on single-patient GAS-positive cultures from 2017 to 2023. Additionally, 10 consecutive, single-patient GAS isolates from 12 hospitals were submitted in May 2023 for whole-genome sequencing and antimicrobial susceptibility testing. RESULTS: In 2023, there was a significant increase in GAS-positive cultures compared to the periods of 2017-2019 (p = 0.002), 2020-2021 (p < 0.00001), and 2022 (p = 0.001), with a disproportionate increase in children. Among 120 isolates, 12 different emm types and 16 multi-locus sequence types (STs) were identified, with emm1 (ST28, 35.0 %) and emm12 (STs 36, 101, 242, 1366, 32.5 %) being the most prevalent. Clonal clustering of emm1 and emm12 isolates across different study sites and geographic regions was demonstrated by whole-genome MLST analysis. When searching for shared virulence genes exclusive to emm1 and emm12 but absent in other emm types, immune evasion and colonisation factors (the streptococcal inhibitor of complement-sic gene in emm1, the distantly related sic-drs gene in emm12, and the sda1 gene in both) were identified. CONCLUSIONS: An upsurge in GAS infections, predominantly caused by emm1 and emm12, was identified in the Czech Republic. The combination of shared virulence factors, altered herd immunity and naïve immunity in children, resulting from contact precautions measures during the COVID-19 pandemic, may have contributed to their increased spread.