The Emm-Cluster Typing System for Group A Streptococcus Identifies Epidemiologic Similarities Across the Pacific Region

Clin Infect Dis. 2014 Oct;59(7):e84-92. doi: 10.1093/cid/ciu490. Epub 2014 Jun 25.


Background: Group A Streptococcus (GAS)-related disease is responsible for high mortality and morbidity in the Pacific region. The high diversity of circulating strains in this region has hindered vaccine development due to apparently low vaccine coverage of type-specific vaccines.

Method: Prospective passive surveillance of all GAS isolates in New Caledonia was undertaken in 2012 using emm typing and emm-cluster typing. Molecular data were compared with the results from a prior study undertaken in the same country and with data from 2 other Pacific countries, Fiji and Australia.

Results: A high incidence of invasive infection was demonstrated at 43 cases per 100 000 inhabitants (95% confidence interval, 35-52 cases per 100 000 inhabitants). Three hundred eighteen GAS isolates belonging to 47 different emm types were collected. In Noumea, only 30% of the isolates recovered in 2012 belonged to an emm type that was present in the same city in 2006, whereas 69% of the isolates collected in 2012 belonged to an emm cluster present in 2006. When comparing New Caledonian, Australian, and Fijian data, very few common emm types were found, but 79%-86% of the isolates from each country belonged to an emm cluster present in all 3 countries. A vaccine that could protect against the 10 most frequent emm clusters in the Pacific region would potentially provide coverage ranging from 83% to 92%.

Conclusions: This study confirms the high disease burden of GAS infection in New Caledonia and supports the added value of the emm-cluster typing system to analyze GAS epidemiology and to help inform global GAS vaccine formulation.

Keywords: Streptococcus pyogenes; emm cluster; invasive diseases; typing; vaccine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, Bacterial / genetics*
  • Bacterial Outer Membrane Proteins / genetics*
  • Carrier Proteins / genetics*
  • Child
  • Child, Preschool
  • Cluster Analysis*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Molecular Epidemiology
  • Molecular Typing*
  • New Caledonia / epidemiology
  • Prospective Studies
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / classification*
  • Streptococcus pyogenes / genetics
  • Streptococcus pyogenes / isolation & purification
  • Young Adult


  • Antigens, Bacterial
  • Bacterial Outer Membrane Proteins
  • Carrier Proteins
  • streptococcal M protein