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Abstract

Incidence of Invasive Group A Streptococcal Infections and Comparison of emm Types from Carriage, Pharyngitis, and Invasive Infections in Indigenous Communities in the Southwest United States †

by
Catherine G. Sutcliffe
1,*,
Victoria M. Sergent
1,
Joyselynn Pitalua
1,
Sopio Chochua
2,
Christopher J. Gregory
2,
Chloe Hurley
1,
Zhongya Li
3,
Saundra Mathis
3,
Lesley McGee
2,
Jennifer Onukwube Okaro
2,
Theresa Tran
2,
Robert Weatherholtz
1 and
Laura L. Hammitt
1
1
Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
2
Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
3
ASRT Inc., Contractor to Pneumonia and Streptococcus Laboratory Branch, Centers for Disease Control and Prevention, Smyrna, GA 30080, USA
*
Author to whom correspondence should be addressed.
†
Presented at the 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases, Brisbane, Australia, 1–5 June 2025.
Proceedings 2025, 124(1), 16; https://doi.org/10.3390/proceedings2025124016
Published: 15 August 2025
(This article belongs to the Proceedings of The 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases (LISSSD 2025))
Versions Notes

Background: Indigenous communities are disproportionately affected by group A Streptococcus (GAS) infections. We determined the incidence of invasive infections in two Indigenous communities in the U.S. and compared emm types from carriage, pharyngitis, and invasive infections. Methods: Study activities included laboratory-based surveillance for invasive GAS infections in White Mountain Apache Tribal (WMAT) lands (2017–2024) and Navajo Nation (NN) (2023–2024); GAS culture of pediatric oropharyngeal carriage samples (2022–2023); and laboratory-based surveillance for pediatric GAS pharyngitis (2023–2024). Emm types were determined by sequencing. We calculated coverage with a 30-valent vaccine in development. Results: In WMAT lands, age-standardized rates of invasive infections were 114–270/100,000 in 2017–2020 and 80–99/100,000 in 2021–2024. Predominant emm types varied: 82 predominated in 2017 (67% of isolates), 91 (59%) and 49 (32%) in 2019–2020, and 43 (40%) and 53 (30%) in 2023. In NN, rates were 40–58/100,000 in 2023–2024; common emm types were 53 (28%), 101 (18%), and 12 (16%). Emm types 1, 12, and 53 predominated in pharyngitis, and 1, 12, and 91 in carriage. The percentage of emm types included in the 30-valent vaccine was higher for carriage (86%/72% in WMAT/NN) and pharyngitis (78%/86%) than invasive infections (39%/43%). Conclusions: Rates of invasive GAS infections in these communities were 3–35 times higher than the national U.S. average (12.9/100,000 in 2023). Emm types varied over time with limited overlap in strains causing carriage/pharyngitis and invasive infections. The findings support expanding GAS surveillance and engaging Indigenous communities during vaccine development and evaluation.

Author Contributions

Conceptualization, methodology and supervision, C.G.S. and L.L.H.; funding acquisition, C.G.S., S.C., L.M. and L.L.H.; data curation and formal analysis, V.M.S.; investigation, J.P., C.H., Z.L. and S.M.; project administration, R.W.; resources, S.C., C.J.G., L.M. and J.O.O.; writing—original draft preparation, C.G.S., V.M.S. and L.L.H.; writing—review and editing, S.C., C.J.G., C.H., Z.L., S.M., L.M., J.O.O., J.P., T.T. and R.W. All authors have read and agreed to the published version of the manuscript.

Funding

This work was funded by the Centers for Disease Control and Prevention through a Broad Agency Announcement (75D30122C15561 to C.G.S.). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Indian Health Service.

Institutional Review Board Statement

The studies were conducted in accordance with the Declaration of Helsinki, and approved by the White Mountain Apache Tribe, the Navajo Nation Human Research Review Board (NNR-07.216, 19 September 2017; NNR-19.343, 15 November 2022; NNR-22.448, 19 July 2022), and the Institutional Review Boards of the Phoenix Area Indian Health Service (PXR 17.08, 31 January 2018; PXR 18.06, 30 May 2018; PXR 22.09, 21 November 2022; PXR 23.01, 8 January 2024) and Johns Hopkins Bloomberg School of Public Health (#8170, 7 September 2017; #8510, 6 April 2018; #9505, 25 October 2022; #20391, 25 May 2022; #24071, 28 February 2023).

Informed Consent Statement

Written informed consent was obtained from all participants involved in the carriage studies. Consent was waived for the invasive disease surveillance and pharyngitis study because they did not involve patient contact. A Health Insurance Portability and Accountability Act (HIPAA) waiver was obtained to conduct medical chart reviews for the invasive and pharyngitis isolates.

Data Availability Statement

Participant data collected on Tribal lands are owned by the participating Tribal Nations. Data can be made available upon request to the corresponding author (contact csutcli1@jhu.edu) if consistent with the Institutional Review Board–approved protocol and if the disclosure is approved by the participating Tribes and the Centers for Disease Control and Prevention.

Conflicts of Interest

Z.L. and S.M. are employed by ASRT Inc. The authors have no conflicts of interest to declare.
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Share and Cite

MDPI and ACS Style

Sutcliffe, C.G.; Sergent, V.M.; Pitalua, J.; Chochua, S.; Gregory, C.J.; Hurley, C.; Li, Z.; Mathis, S.; McGee, L.; Okaro, J.O.; et al. Incidence of Invasive Group A Streptococcal Infections and Comparison of emm Types from Carriage, Pharyngitis, and Invasive Infections in Indigenous Communities in the Southwest United States. Proceedings 2025, 124, 16. https://doi.org/10.3390/proceedings2025124016

AMA Style

Sutcliffe CG, Sergent VM, Pitalua J, Chochua S, Gregory CJ, Hurley C, Li Z, Mathis S, McGee L, Okaro JO, et al. Incidence of Invasive Group A Streptococcal Infections and Comparison of emm Types from Carriage, Pharyngitis, and Invasive Infections in Indigenous Communities in the Southwest United States. Proceedings. 2025; 124(1):16. https://doi.org/10.3390/proceedings2025124016

Chicago/Turabian Style

Sutcliffe, Catherine G., Victoria M. Sergent, Joyselynn Pitalua, Sopio Chochua, Christopher J. Gregory, Chloe Hurley, Zhongya Li, Saundra Mathis, Lesley McGee, Jennifer Onukwube Okaro, and et al. 2025. "Incidence of Invasive Group A Streptococcal Infections and Comparison of emm Types from Carriage, Pharyngitis, and Invasive Infections in Indigenous Communities in the Southwest United States" Proceedings 124, no. 1: 16. https://doi.org/10.3390/proceedings2025124016

APA Style

Sutcliffe, C. G., Sergent, V. M., Pitalua, J., Chochua, S., Gregory, C. J., Hurley, C., Li, Z., Mathis, S., McGee, L., Okaro, J. O., Tran, T., Weatherholtz, R., & Hammitt, L. L. (2025). Incidence of Invasive Group A Streptococcal Infections and Comparison of emm Types from Carriage, Pharyngitis, and Invasive Infections in Indigenous Communities in the Southwest United States. Proceedings, 124(1), 16. https://doi.org/10.3390/proceedings2025124016

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