title: Whole genome sequencing reveals extensive community-level transmission of group A Streptococcus in remote communities.
abstract: Impetigo is common in remote Indigenous children of northern Australia, with the primary driver in this context being Streptococcus pyogenes [or group A Streptococcus (GAS)]. To reduce the high burden of impetigo, the transmission dynamics of GAS must be more clearly elucidated. We performed whole genome sequencing on 31 GAS isolates collected in a single community from children in 11 households with ⩾2 GAS-infected children. We aimed to determine whether transmission was occurring principally within households or across the community. The 31 isolates were represented by nine multilocus sequence types and isolates within each sequence type differed from one another by only 0-3 single nucleotide polymorphisms. There was evidence of extensive transmission both within households and across the community. Our findings suggest that strategies to reduce the burden of impetigo in this setting will need to extend beyond individual households, and incorporate multi-faceted, community-wide approaches.
authors.affiliation: Menzies School of Health Research,Charles Darwin University,Darwin,NT,Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Bowen
authors.affiliation: Menzies School of Health Research,Charles Darwin University,Darwin,NT,Australia.
authors.forename: T
authors.initials: T
authors.lastname: Harris
authors.affiliation: Menzies School of Health Research,Charles Darwin University,Darwin,NT,Australia.
authors.forename: D C
authors.initials: DC
authors.lastname: Holt
authors.affiliation: Menzies School of Health Research,Charles Darwin University,Darwin,NT,Australia.
authors.forename: P M
authors.initials: PM
authors.lastname: Giffard
authors.affiliation: Princess Margaret Hospital for Children,Perth,WA,Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Carapetis
authors.affiliation: University of Melbourne,Melbourne,VIC,Australia.
authors.forename: P T
authors.initials: PT
authors.lastname: Campbell
authors.affiliation: University of Melbourne,Melbourne,VIC,Australia.
authors.forename: J
authors.initials: J
authors.lastname: McVERNON
authors.affiliation: Menzies School of Health Research,Charles Darwin University,Darwin,NT,Australia.
authors.forename: S Y C
authors.identifier: 0000-0002-1368-8356
authors.initials: SY
authors.lastname: Tong
mesh_terms: D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious; D005191:Family Characteristics; D005260:Female; D014644:Genetic Variation; D016680:Genome, Bacterial; D005838:Genotype; D006801:Humans; D007169:Impetigo / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA; D013297:Streptococcus pyogenes / Q000145:classification* / Q000302:isolation & purification*
keywords: Impetigo; Streptococcus pyogenes; infectious disease epidemiology; transmission
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