Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017

Laura Bubba; Nick Bundle; Georgia Kapatai; Roger Daniel; Sooria Balasegaram; Charlotte Anderson; Victoria Chalker; Theresa Lamagni; Colin Brown; Derren Ready; Androulla Efstratiou; Juliana Coelho

doi:10.1016/j.jinf.2019.08.009

Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017

Laura Bubba^*, Nick Bundle, Georgia Kapatai, Roger Daniel, Sooria Balasegaram, Charlotte Anderson, Victoria Chalker, Theresa Lamagni, Colin Brown, Derren Ready, Androulla Efstratiou, Juliana Coelho

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical – 2005–2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0–16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93–8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition.

Original language	English
Pages (from-to)	435-443
Number of pages	9
Journal	Journal of Infection
Volume	79
Issue number	5
DOIs	https://doi.org/10.1016/j.jinf.2019.08.009
Publication status	Published - Nov 2019

Bibliographical note

Funding Information:
We would like to thank all outbreak investigation teams, listed in alphabetical order, for their role in investigating the outbreak: Surrey and Sussex and South West Health Protection Teams: Rachel Cloke, Max Courtney-Pillinger, Sarah King, Rachel Kwiatkowska and Jill Rajan-Iyer; National Infection Service, Colindale: Monica Desai, Rachel Glass, Vivian Hope; Chenchal Dhami Field Epidemiology Services: Maya Gobin, Charles Beck, Daiga Jermacane (EPIET Alumna). The authors would like to thank Aftab Jasir for her critical reading of the paper and her precious suggestions and Natalie Groves for her help with accession number submission.

Keywords

England
Group A streptococcus
Homeless
Outbreak
People reporting problematic alcohol use
People who inject drugs
Streptococcus pyogenes
Wales
Whole genome sequencing
emm66

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jinf.2019.08.009

Cite this

Bubba, L., Bundle, N., Kapatai, G., Daniel, R., Balasegaram, S., Anderson, C., Chalker, V., Lamagni, T., Brown, C., Ready, D., Efstratiou, A., & Coelho, J. (2019). Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017. Journal of Infection, 79(5), 435-443. https://doi.org/10.1016/j.jinf.2019.08.009

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title = "Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017",

abstract = "An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical – 2005–2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0–16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93–8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition.",

keywords = "England, Group A streptococcus, Homeless, Outbreak, People reporting problematic alcohol use, People who inject drugs, Streptococcus pyogenes, Wales, Whole genome sequencing, emm66",

author = "Laura Bubba and Nick Bundle and Georgia Kapatai and Roger Daniel and Sooria Balasegaram and Charlotte Anderson and Victoria Chalker and Theresa Lamagni and Colin Brown and Derren Ready and Androulla Efstratiou and Juliana Coelho",

note = "Funding Information: We would like to thank all outbreak investigation teams, listed in alphabetical order, for their role in investigating the outbreak: Surrey and Sussex and South West Health Protection Teams: Rachel Cloke, Max Courtney-Pillinger, Sarah King, Rachel Kwiatkowska and Jill Rajan-Iyer; National Infection Service, Colindale: Monica Desai, Rachel Glass, Vivian Hope; Chenchal Dhami Field Epidemiology Services: Maya Gobin, Charles Beck, Daiga Jermacane (EPIET Alumna). The authors would like to thank Aftab Jasir for her critical reading of the paper and her precious suggestions and Natalie Groves for her help with accession number submission.",

year = "2019",

month = nov,

doi = "10.1016/j.jinf.2019.08.009",

language = "English",

volume = "79",

pages = "435--443",

journal = "Journal of Infection",

issn = "0163-4453",

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Bubba, L, Bundle, N, Kapatai, G, Daniel, R, Balasegaram, S , Anderson, C, Chalker, V, Lamagni, T , Brown, C, Ready, D, Efstratiou, A & Coelho, J 2019, 'Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017', Journal of Infection, vol. 79, no. 5, pp. 435-443. https://doi.org/10.1016/j.jinf.2019.08.009

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T1 - Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017

AU - Bubba, Laura

AU - Bundle, Nick

AU - Kapatai, Georgia

AU - Daniel, Roger

AU - Balasegaram, Sooria

AU - Anderson, Charlotte

AU - Chalker, Victoria

AU - Lamagni, Theresa

AU - Brown, Colin

AU - Ready, Derren

AU - Efstratiou, Androulla

AU - Coelho, Juliana

N1 - Funding Information: We would like to thank all outbreak investigation teams, listed in alphabetical order, for their role in investigating the outbreak: Surrey and Sussex and South West Health Protection Teams: Rachel Cloke, Max Courtney-Pillinger, Sarah King, Rachel Kwiatkowska and Jill Rajan-Iyer; National Infection Service, Colindale: Monica Desai, Rachel Glass, Vivian Hope; Chenchal Dhami Field Epidemiology Services: Maya Gobin, Charles Beck, Daiga Jermacane (EPIET Alumna). The authors would like to thank Aftab Jasir for her critical reading of the paper and her precious suggestions and Natalie Groves for her help with accession number submission.

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N2 - An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical – 2005–2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0–16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93–8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition.

AB - An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical – 2005–2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0–16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93–8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition.

KW - England

KW - Group A streptococcus

KW - Homeless

KW - Outbreak

KW - People reporting problematic alcohol use

KW - People who inject drugs

KW - Streptococcus pyogenes

KW - Wales

KW - Whole genome sequencing

KW - emm66

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U2 - 10.1016/j.jinf.2019.08.009

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AN - SCOPUS:85070893562

SN - 0163-4453

VL - 79

SP - 435

EP - 443

JO - Journal of Infection

JF - Journal of Infection

IS - 5

ER -

Genomic sequencing of a national emm66 group A streptococci (GAS) outbreak among people who inject drugs and the homeless community in England and Wales, January 2016–May 2017

Abstract

Bibliographical note

Keywords

UN SDGs

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