Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development

ABSTRACT An emm-cluster based system was proposed as a standard typing scheme to facilitate and enhance future studies of group A Streptococcus (GAS) epidemiological surveillance, M protein function, and vaccine development strategies. We provide an evidence-based distribution of GAS emm clusters in...

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Autores principales:	Taariq Salie, Kelin Engel, Annesinah Moloi, Babu Muhamed, James B. Dale, Mark E. Engel
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2020
Materias:	group A Streptococcus Streptococcus pyogenes GAS M protein emm clustering system epidemiology Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/ac2b3fcc9c234bc7b1f167c2666cee2f
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spelling	oai:doaj.org-article:ac2b3fcc9c234bc7b1f167c2666cee2f2021-11-15T15:30:50ZSystematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development10.1128/mSphere.00429-202379-5042https://doaj.org/article/ac2b3fcc9c234bc7b1f167c2666cee2f2020-08-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mSphere.00429-20https://doaj.org/toc/2379-5042ABSTRACT An emm-cluster based system was proposed as a standard typing scheme to facilitate and enhance future studies of group A Streptococcus (GAS) epidemiological surveillance, M protein function, and vaccine development strategies. We provide an evidence-based distribution of GAS emm clusters in Africa and assess the potential coverage of the new 30-valent vaccine in terms of an emm cluster-based approach. Two reviewers independently assessed studies retrieved from a comprehensive search and extracted relevant data. Meta-analyses were performed (random-effects model) to aggregate emm cluster prevalence estimates. Eight studies (n = 1,595 isolates) revealed the predominant emm clusters as E6 (18%; 95% confidence interval [CI], 12.6% to 24.0%), followed by E3 (14%; 95% CI, 11.2% to 17.4%) and E4 (13%; 95% CI, 9.5% to 16.0%). There was negligible variation in emm clusters with regard to regions, age, and socioeconomic status across the continent. Considering an emm cluster-based vaccine strategy, which assumes cross-protection within clusters, the 30-valent vaccine currently in clinical development would provide hypothetical coverage to 80.3% of isolates in Africa. This systematic review indicates the most predominant GAS emm cluster in Africa is E6 followed by E3, E4, and D4. The current 30-valent vaccine would provide considerable coverage across the diversity of emm cluster types in Africa. Future efforts could be directed toward estimating the overall potential coverage of the new 30-valent vaccine based on cross-opsonization studies with representative panels of GAS isolates from populations at highest risk for GAS diseases. IMPORTANCE Low vaccine coverage is of grave public health concern, particularly in developing countries where epidemiological data are often absent. To inform vaccine development for group A Streptococcus (GAS), we report on the epidemiology of the M protein emm clusters from GAS infections in Africa, where GAS-related illnesses and their sequelae, including rheumatic fever and rheumatic heart disease, are of a high burden. This first report of emm clusters across the continent indicates a high probably of coverage by the M protein-based vaccine currently undergoing testing were an emm-cluster based approach to be used.Taariq SalieKelin EngelAnnesinah MoloiBabu MuhamedJames B. DaleMark E. EngelAmerican Society for Microbiologyarticlegroup A StreptococcusStreptococcus pyogenesGASM proteinemm clustering systemepidemiologyMicrobiologyQR1-502ENmSphere, Vol 5, Iss 4 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	group A Streptococcus Streptococcus pyogenes GAS M protein emm clustering system epidemiology Microbiology QR1-502
spellingShingle	group A Streptococcus Streptococcus pyogenes GAS M protein emm clustering system epidemiology Microbiology QR1-502 Taariq Salie Kelin Engel Annesinah Moloi Babu Muhamed James B. Dale Mark E. Engel Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
description	ABSTRACT An emm-cluster based system was proposed as a standard typing scheme to facilitate and enhance future studies of group A Streptococcus (GAS) epidemiological surveillance, M protein function, and vaccine development strategies. We provide an evidence-based distribution of GAS emm clusters in Africa and assess the potential coverage of the new 30-valent vaccine in terms of an emm cluster-based approach. Two reviewers independently assessed studies retrieved from a comprehensive search and extracted relevant data. Meta-analyses were performed (random-effects model) to aggregate emm cluster prevalence estimates. Eight studies (n = 1,595 isolates) revealed the predominant emm clusters as E6 (18%; 95% confidence interval [CI], 12.6% to 24.0%), followed by E3 (14%; 95% CI, 11.2% to 17.4%) and E4 (13%; 95% CI, 9.5% to 16.0%). There was negligible variation in emm clusters with regard to regions, age, and socioeconomic status across the continent. Considering an emm cluster-based vaccine strategy, which assumes cross-protection within clusters, the 30-valent vaccine currently in clinical development would provide hypothetical coverage to 80.3% of isolates in Africa. This systematic review indicates the most predominant GAS emm cluster in Africa is E6 followed by E3, E4, and D4. The current 30-valent vaccine would provide considerable coverage across the diversity of emm cluster types in Africa. Future efforts could be directed toward estimating the overall potential coverage of the new 30-valent vaccine based on cross-opsonization studies with representative panels of GAS isolates from populations at highest risk for GAS diseases. IMPORTANCE Low vaccine coverage is of grave public health concern, particularly in developing countries where epidemiological data are often absent. To inform vaccine development for group A Streptococcus (GAS), we report on the epidemiology of the M protein emm clusters from GAS infections in Africa, where GAS-related illnesses and their sequelae, including rheumatic fever and rheumatic heart disease, are of a high burden. This first report of emm clusters across the continent indicates a high probably of coverage by the M protein-based vaccine currently undergoing testing were an emm-cluster based approach to be used.
format	article
author	Taariq Salie Kelin Engel Annesinah Moloi Babu Muhamed James B. Dale Mark E. Engel
author_facet	Taariq Salie Kelin Engel Annesinah Moloi Babu Muhamed James B. Dale Mark E. Engel
author_sort	Taariq Salie
title	Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
title_short	Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
title_full	Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
title_fullStr	Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
title_full_unstemmed	Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development
title_sort	systematic review and meta-analysis of the prevalence of group a streptococcal <italic toggle="yes">emm</italic> clusters in africa to inform vaccine development
publisher	American Society for Microbiology
publishDate	2020
url	https://doaj.org/article/ac2b3fcc9c234bc7b1f167c2666cee2f
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Systematic Review and Meta-analysis of the Prevalence of Group A Streptococcal <italic toggle="yes">emm</italic> Clusters in Africa To Inform Vaccine Development

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