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Review
. 2022 Dec 30;14(12):e33146.
doi: 10.7759/cureus.33146. eCollection 2022 Dec.

Group A Streptococcus Infections: Their Mechanisms, Epidemiology, and Current Scope of Vaccines

Vinayak Iyer  1 , Vivek Sagar  2 , Devinder Toor  3 , Valarie Lyngdoh  4 , Gloria Nongrum  4 , Manish Kapoor  5 , Anuradha Chakraborti  1
Affiliations
Review

Group A Streptococcus Infections: Their Mechanisms, Epidemiology, and Current Scope of Vaccines

Vinayak Iyer et al. Cureus. .

Abstract

Group A streptococci (GAS) are gram-positive, cocci-shaped bacteria that cause a wide variety of infections and are a cause of significant health burden, particularly in lower- and middle-income nations. The GAS genome contains a number of virulence factors such as the M-protein, hyaluronic acid, C5a peptidase, etc. Despite its significant health burden across the globe, a proper vaccine against GAS infections is not yet available. Various candidates for an effective GAS vaccine are currently being researched. These are based on various parts of the streptococcal genome. These include candidates based on the N-terminal region of the M protein, the conserved C-terminal region of the M protein, and other parts of the streptococcal genome. The development of a vaccine against GAS infections is hampered by certain challenges, such as extensive genetic heterogeneity and high protein sequence variation. This review paper sheds light on the various virulence factors of GAS, their epidemiology, the different vaccine candidates currently being researched, and the challenges associated with M-protein and non-M-protein-based vaccines. This review also sheds light on the current scenario regarding the status of vaccine development against GAS-related infections.

Keywords: emm gene; group a streptococcus; rheumatic heart disease; streptococcus pyogenes; vaccine.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Basic structure of M-protein. The site of pepsin cleavage is indicated and occurs usually after the 228th amino acid.
Note: This image is the author's own creation.
Figure 2
Figure 2. Emm type distribution in various regions around the world.
(a) Bocking et al. [48] (Canada) (n= 46; where n is the total number of emm-typed isolates that were obtained). (b) Barth et al. [50] (South Africa) (n= 233). (c) Steer et al. [51] (Fiji) (Pacific region; n=55). (d) Oliver et al. [52] (Australia) (n= 96). Note: All the pie charts in the figure are the author's own creation.
Figure 3
Figure 3. Emm type distribution in various regions of India.
(a) Dhanda et al. [58] (North India) (n=71; where n is the total number of GAS isolates that could be characterized for their emm type). (b) Devi et al. [59] (East India) (n=14). (c) Ray et al. [60] (East) (n=140). (d) Balaji et al. [61] (South) (n=67). (e) Haggar et al. [62] (North and South (cohort study)) (n=49). (f) Arya et al. [69] (North and West) (n=92). (g) Dey et al. [64] (North) (n=59). (h) Sagar et al. [66] (North and South) (n=201). Note: All the pie charts in the figure are the author's own creation.
Figure 4
Figure 4. Timeline of M-protein-based vaccines (from 1946 to 2011).
Note: This image is the author's own creation.
See this image and copyright information in PMC

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