Analysis of public health risks and countermeasures for group A streptococcal disease

Group A streptococcus (GAS) is a common human pathogenic bacterium that causes a variety of clinical diseases. It is also a pathogen that can cause varying extends of clustered outbreaks or epidemics. There have been multiple resurgences since the 1980s. In 2011, multiple Asian countries reported a resurgence in the incidence of GAS disease. Outbreak of scarlet fever and invasive GAS infections were reported in the United Kingdom from the end of 2022 to the beginning of 2023. An outbreak of streptococcal toxic shock syndrome caused by GAS was reported in Japan from January to March 2024, which attracted international public attention. Over the past 40 years, GAS have developed several lineages with enhanced pathogenicity, such as M1T1 and M1_UK, which are associated with increased levels of the incidence. Here we review the prevalence and resurgence of GAS worldwide in recent years as well as the characteristics of pathogenicity. We also analyze the epidemic risks, existing problems, and challenges in China, which would provide reference for the prevention and control of Group A streptococcal disease in China.