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Background  An experimental 26-valent M protein Group A streptococcal (GAS) vaccine has entered clinical studies. Pharyngeal GAS  emm  type surveillances in different areas and time-periods enhance the understanding of the epidemiology of GAS pharyngitis. Moreover, these surveillances, combined with the data on GAS invasive disease, can play a significant role in the formulation of multivalent type-specific vaccines.    Methods  During a 7-year period (1999–2005), 2408 GAS isolates were recovered from consecutive children with pharyngitis in Western Greece. The overall macrolide resistance rate was 22.8%. Along the study period we noted a tendency towards significantly decreased rates of resistance, with the lowest rates occurring in 2002 (15.3%), 2003 (15%) and 2004 (16.7%). A random sample of isolates from each year, 338 (61.7%) of the 548 macrolide-resistant and 205 (11%) of the macrolide-susceptible, underwent molecular analysis, including  emm  typing.    Results  The 543 typed isolates had 28 different  emm  types. A statistically significant association was found between macrolide resistance and  emm 4,  emm 22 and  emm 77, whereas  emm 1,  emm 3,  emm 6,  emm 12,  emm 87 and  emm 89 were associated with macrolide susceptibility. A significant yearly fluctuation was observed in  emm 4,  emm 28 and  emm 77. The most common macrolide-resistant GAS were  emm 77 isolates harboring  erm (A), either alone or in combination with  mef (A),  emm 4 carrying  mef (A),  emm 28 possessing  erm (B),  emm 75 carrying  mef (A),  emm 12 harboring  mef (A) and  emm 22 carrying  erm (A). We estimated that 82.8% of the isolates belonged to  emm  types included in the novel 26-valent M protein vaccine. The vaccine coverage rate was determined mainly by the increased frequency of nonvaccine  emm 4 isolates.    Conclusions  A limited number of  emm  types dominated among macrolide-susceptible and macrolide-resistant GAS isolates. We observed seasonal fluctuations, which were significant for  emm 4,  emm 28 and  emm 77. This type of data can serve as baseline information if the novel 26-valent M protein GAS vaccine is introduced into practice.

Seven-Year Surveillance of emm Types of Pediatric Group A Streptococcal Pharyngitis Isolates in Western Greece