Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 31, Number 2—February 2025
Research

Streptococcus pyogenes emm Type 3.93 Emergence, the Netherlands and England

Matthew A. Davies1, Brechje de Gier1, Rebecca L. Guy, Juliana Coelho, Alje P. van Dam, Robin van Houdt, Sébastien Matamoros, Marit van den Berg, Patrick E. Habermehl, Kartyk Moganeradj, Yan Ryan, Steve Platt, Henry Hearn, Eleanor Blakey, Darren Chooneea, Bart J.M. Vlaminckx, Theresa Lamagni, and Nina M. van SorgeComments to Author 
Author affiliation: Amsterdam University Medical Center, Amsterdam, the Netherlands (M.A. Davies, A.P. van Dam, R. van Houdt, S. Matamoros, M. van den Berg, P.E. Habermehl, N.M. van Sorge); National Institute for Public Health and the Environment, Bilthoven, the Netherlands (B. de Gier); UK Health Security Agency, London, UK (R.L. Guy, J. Coelho, K. Moganeradj, Y. Ryan, S. Platt, H. Hearn, E. Blakey, D. Chooneea, T. Lamagni); University Medical Center Utrecht, Utrecht, the Netherlands (B.J.M. Vlaminckx)

Main Article

Table 1

Characteristics of patients with invasive group A Streptococcus infection in the Netherlands and England caused by emm3.93 or other emm types during November 1, 2023–March 31, 2024*

Characteristic
 The Netherlands
England
emm3.93, no. (%)
 Other emm type, no. (%)
 aOR (95% CI)
 p value
 emm3.93, no. (%)
 Other emm type, no. (%)
 aOR (95% CI)
 p value
No. patients
 319
 346
240
 1,158
Age group, y
0–5 23 (7.2) 17 (4.9) 1.5 (0.7–3.2) 0.2675 30 (12.5) 93 (8.0) 1.7 (1.1–2.8) 0.030
6–17 33 (10.3) 16 (4.6) 2.4 (1.2–5.0) 0.0139 30 (12.5) 60 (5.2) 2.4 (1.4–3.9) 0.001
18–44 65 (20.4) 112 (32.4) 0.6 (0.4–0.9) 0.0204 31 (12.9) 284 (24.5) 0.6 (0.4–0.9) 0.022
45–64 76 (23.8) 84 (24.3) 0.9 (0.6–1.3) 0.5046 63 (26.3) 258 (22.3) 1.4 (0.9–2.0) 0.103
>65
 122 (38.2)
 117 (33.8)
 Referent
86 (35.8)
 463 (40.0)
 Referent
Sex
M 151 (47.3) 159 (46.0) Referent 123 (51.3) 667 (57.6) Referent
F
 168 (52.7)
 187 (54.0)
 1.1 (0.8–1.5)
 0.5416
115 (47.9)
 477 (41.2)
 1.4 (1.0–1.8)
 0.033
STSS
No 265 (88.9) 318 (95.2) Referent
Yes
 33 (11.1)
 16 (4.8)
 2.2 (1.1–4.3)
 0.0225
Necrotizing fasciitis
No 279 (93.6) 302 (90.4) Referent
Yes
 19 (6.4)
 32 (9.6)
 0.7 (0.4–1.4)
 0.3468
Puerperal fever or sepsis
No 270 (90.6) 273 (81.7) Referent
Yes
 28 (9.4)
 61 (18.3)
 0.5 (0.3–0.8)
 0.004
Meningitis†
No 286 (96.0) 328 (98.2) Referent 228 (98.3) 1,058 (99.9) Referent
Yes
 12 (4.0)
 6 (1.8)
 2.7 (0.9–8.8)
 0.0818
4 (1.7)
 1 (0.1)
 28.6 (2.6–320.1)
 0.006
Bone or joint infection‡
No 271 (90.9) 312 (93.4) Referent 221 (95.3) 1,006 (95.0) Referent
Yes
 27 (9.1)
 22 (6.6)
 1.2 (0.6–2.4)
 0.586
11 (4.7)
 53 (5.0)
 1.1 (0.6–2.3)
 0.858
Pneumonia/pleural empyema§
No 217 (72.8) 298 (89.2) Referent 218 (94.3) 1,039 (98.1) Referent
Yes
 81 (27.2)
 36 (10.8)
 2.9 (1.9–4.6)
 <0.001
14 (6.0)
 20 (1.9)
 3.4 (1.6–73)
 0.001
Cardiovascular infection
No 297 (99.7) 329 (98.5) Referent
Yes
 1 (0.3)
 5 (1.5)
 0.2 (0.0–1.8)
 0.2252
Skin and soft tissue infection
No 260 (87.2) 264 (79.0) Referent
Yes
 38 (12.8)
 70 (21.0)
 0.5 (0.3–0.8)
 0.0032
Sepsis
No 231 (77.5) 240 (71.9) Referent
Yes
 67 (22.5)
 94 (28.1)
 0.7 (0.5–1.0)
 0.055
Month
2023 Nov 4 (1.3) 63 (18.2) Referent 9 (3.8) 218 (18.8) Referent
2023 Dec 60 (18.8) 74 (21.4) 12.5 (4.8–43.2) <0.0001 44 (18.3) 223 (19.3) 4.7 (2.2–9.9) <0.0001
2024 Jan 86 (27.0) 73 (21.1) 19.1 (7.3–65.6) <0.0001 61 (25.4) 258 (22.3) 5.7 (2.8–11.8) <0.0001
2024 Feb 102 (32.0) 69 (19.9) 24.1 (9.3–82.6) <0.0001 62 (25.8) 227 (19.6) 6.3 (3.1–13.2) <0.0001
2024 Mar 67 (21.0) 67 (19.4) 14.8 (5.7–51.2) <0.0001 64 (26.7) 232 (20.0) 6.7 (3.2–13.8) <0.0001

*Odds ratios for age group, sex, and month are derived from a multivariable model containing those 3 variables. Odds ratios for clinical manifestations are adjusted for age group, sex, and month, but the puerperal fever or sepsis aOR is adjusted for month only. aOR, adjusted odds ratio; STSS, streptococcal toxic shock syndrome. †Cerebral spinal fluid specimens used as proxy in data from England. ‡Joint or synovial fluid specimens used for data from England. §Pleural specimens used as proxy for data from England.

Main Article

1These authors contributed equally.

Page created: December 30, 2024
Page updated: January 22, 2025
Page reviewed: January 22, 2025
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external