title: Epidemiological and Molecular Characterization of an Invasive Group A Streptococcusemm32.2 Outbreak.
abstract: Anemm32.2 invasive group A streptococcus (iGAS) outbreak occurred in Liverpool from January 2010 to September 2012. This genotype had not previously been identified in Liverpool, but was responsible for 32% (14/44) of all iGAS cases reported during this time period. We performed a case-case comparison ofemm32.2 iGAS cases with non-emm32.2 control iGAS cases identified in the Liverpool population over the same time period to assess patient risk factors foremm32.2 iGAS infection. Theemm32.2 iGAS cases were confined to the adult population. We show that homelessness, intravenous drug use, and alcohol abuse predisposed patients toemm32.2 iGAS disease; however, no obvious epidemiological linkage between the patients withemm32.2 iGAS could be identified. Comparative whole-genome sequencing analysis ofemm32.2 iGAS and non-emm32.2 control isolates was also performed to identify pathogen factors which might have driven the outbreak. We identified 19 genes, five of which had previously been implicated in virulence, which were present in all of theemm32.2 iGAS isolates but not present in any of the non-emm32.2 control isolates. We report that a novelemm32.2 genotype emerged in Liverpool in 2010 and identified a specific subset of genes, which could have allowed this novelemm32.2 genotype to persist in a disadvantaged population in the region over a 3-year period.
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi J.Cornick@liverpool.ac.uk.|Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cornick
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.|Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Anmol M
authors.initials: AM
authors.lastname: Kiran
authors.affiliation: Field Epidemiology Service, Public Health England, London, United Kingdom.|NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vivancos
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Van Aartsen
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Jenny
authors.initials: J
authors.lastname: Clarke
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.|Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Bevan
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Alsahag
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.|Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Maaike
authors.initials: M
authors.lastname: Alaearts
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Bricio Moreno
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Howard F
authors.identifier: 0000-0002-9195-7945
authors.initials: HF
authors.lastname: Jenkinson
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, United Kingdom.
authors.forename: Angela H
authors.initials: AH
authors.lastname: Nobbs
authors.affiliation: Liverpool Clinical Laboratories, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Anson
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Aras
authors.initials: A
authors.lastname: Kadioglu
authors.affiliation: Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.|Liverpool Clinical Laboratories, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: French
authors.affiliation: Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.|Institute of Infection & Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Dean B
authors.initials: DB
authors.lastname: Everett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000235:genetics*; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics*; D002352:Carrier Proteins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006113:United Kingdom / Q000453:epidemiology; D000073336:Whole Genome Sequencing; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; C014689:streptococcal M protein
keywords: Streptococcus pyogenes; accessory genome; antibiotic resistance; comparative genomics; epidemiological data; iGAS; molecular epidemiology; phylogeny; streptococci; virulence factors; whole-genome sequencing