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emm Types as Proportions of Total Disease Isolates in Six Global Regions

Steer AC, I Law, L. Matatolu, BW Beall, JR Carapetis. 2009. Global emm type distribution of group A streptococci: systematic review and implications for vaccine development. Lancet Infect Dis 9:611-616.

 

Supplementary Figures 1-A through 1-F

Supplementary Figures. The 25 most common emm types as proportions of total isolates in six global regions (black bars represent emm types that are included in the current experimental multivalent group A streptococcal vaccine, whilst white bars represent those emm types that are not included; the dotted line represents the cumulative percentage of all isolates).

The 25 most common emm types contributing to disease in Africa

Fig 1-A: The 25 most common emm types contributing to disease in Africa
The 25 most common emm types contributing to disease in Africa (there was a further emm type not included on this graph that was equal 25th; this was emm112): these 26 emm types accounted for 62.5% of all isolates from the region with 65 types contributing to the remaining 37.5% of isolates. Emm12, emm75, st62, emm74, emm1, emm3, st463, emm25, emm18, emm28, emm9, emm5, st171, emm71, st375, emm22, emm77, emm99, emm8,. Emm81, emm76, emm103, emm44, em114, emm43.

Figure 1-A. The 25 most common emm types contributing to disease in Africa (there was a further emm type not included on this graph that was equal 25th; this was emm112): these 26 emm types accounted for 62.5% of all isolates from the region with 65 types contributing to the remaining 37.5% of isolates.  

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The 25 most common emm types contributing to all disease in Asia

Fig 1-B: The 25 most common emm types contributing to all disease in Asia: accounts for 91.1% of all isolates from the region with 68 types contributing to the remaining 8.9% of isolates. Emm1, emm12, emm4, emm6, emm44, nontypeable, emm22, emm75, stIL103, emm77, emm81, emm11, emm71, emm93, emm49, emm3, emm25, emm18, emm, emm28, emm74, emm92, emm2, st11014, emm82.

Figure 1-B. The 25 most common emm types contributing to all disease in Asia: accounts for 91.1% of all isolates from the region with 68 types contributing to the remaining 8.9% of isolates.

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The 25 most common emm types contributing to disease in Latin America

Fig 1-C: Figure 1-C. The 25 most common emm types contributing to disease in Latin America (there was a further emm type not included on this graph that was equal 25th; this was emm66): these 26 emm types accounted for 88.4% of all isolates from the region with 42 types contributing to the remaining 11.6% of isolates.  Emm1, emm12, emm2, emm3, emm22, emm75, emm6, emm4, emm77, emm92, emm89, emm18, emm9, emm87, emm53, emm5, emm49, emm58, emm33, emm28, emm59, emm83, emm78, emm11, emm92.

Figure 1-C. The 25 most common emm types contributing to disease in Latin America (there was a further emm type not included on this graph that was equal 25th; this was emm66): these 26 emm types accounted for 88.4% of all isolates from the region with 42 types contributing to the remaining 11.6% of isolates.

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The 25 most common emm types contributing to all disease in Middle East countries

Fig 1-D:  The 25 most common emm types contributing to all disease in Middle East countries: accounts for 91.8% of all isolates from the region with 38 types contributing to the remaining 8.2% of isolates. Nontypeable, emm12, emm1, emm3, emm28, emm4, emm6, emm2, emm13, emm5, emm11, emm89, emm9, emm62, emm14, emm41, emm83, emm22, emm18, emm49, emm19, emm33, emm76, emm5, emm87.

Figure 1-D. The 25 most common emm types contributing to all disease in Middle East countries: accounts for 91.8% of all isolates from the region with 38 types contributing to the remaining 8.2% of isolates.

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The 25 most common emm types contributing to disease in the Pacific Island Countries/ Indigenous Australians

Fig1-E: The 25 most common emm types contributing to disease in the Pacific Island Countries/ Indigenous Australians (there was a further emm type not included on this graph that was equal 25th; this was emm74): these 26 emm types accounted for 61.8% of all isolates from the region with 74 types contributing to the remaining 38.2% of isolates. Emm55, nontypeable, emm11, emm70, emm33, emm25, emm44, MS3/80, emm103, emm76, emm89, emm100, emm1, emm71, emm22, emm93, emm52, emm91, emm73, emm69, stNS1033, emm56, emm58, emm78, emm14.

Figure 1-E. The 25 most common emm types contributing to disease in the Pacific Island Countries/ Indigenous Australians (there was a further emm type not included on this graph that was equal 25th; this was emm74): these 26 emm types accounted for 61.8% of all isolates from the region with 74 types contributing to the remaining 38.2% of isolates.

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The 25 most common emm types contributing to all disease in Established Market Economy countries

Fig 1-F: The 25 most common emm types contributing to all disease in Established Market Economy countries: accounts for 90.3% of all isolates from the region with 146 types contributing to the remaining 9.7% of isolates. Emm1, emm12, emm28, emm3, emm4, emm89, nontypeable, emm6, emm75, emm77, emm2, emm11, emm22, emm81, emm87, emm5, emm49, emm53, emm58, emm44, emm82, emm73, emm83, emm18, emm92.

Figure 1-F. The 25 most common emm types contributing to all disease in Established Market Economy countries: accounts for 90.3% of all isolates from the region with 146 types contributing to the remaining 9.7% of isolates.

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Supplementary Figures 2-A through 2-P

Supplementary Figures. The 25 most common emm types causing invasive, pharyngeal and skin disease, as proportions of total isolates in 6 global regions (black bars represent emm types that are included in the current experimental multivalent group A streptococcal vaccine, whilst white bars represent those emm types that are not included; the dotted line represents the cumulative percentage of all isolates).

The 25 most common emm types contributing to invasive disease in Asia

Fig 2-A: The 25 most common emm types contributing to invasive disease in Asia: there were a total of 30 emm types. Emm1, emm12, emm8, emm18, emm22, emm80, emm95, emm25, stNS1033, emm101, emm61, emm23, emm119, emm66, emm94, emm3, emm4, emm77, emm92, st2904, emm85, emm86, emm88, emm49.

Figure 2-A. The 25 most common emm types contributing to invasive disease in Asia: there were a total of 30 emm types.

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The 25 most common emm types contributing to invasive disease in Latin America

Fig 2-B: The 25 most common emm types contributing to invasive disease in Latin America: there were a total of 35 emm types. Emm1, emm12, emm75, emm2, emm6, emm4, emm18, emm92, emm22, emm87, emm3, emm82, emm66, emm77, emm78, emm89, emm11, emm9, emm49, emm58, emm59, emm33, emm43, emm83, emm5.

Figure 2-B. The 25 most common emm types contributing to invasive disease in Latin America: there were a total of 35 emm types.

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The 25 most common emm types contributing to invasive disease in the Middle East

Fig 2-C: The 25 most common emm types contributing to invasive disease in the Middle East: there were a total of 59 emm types. Emm3, emm28, nontypeable, emm2, emm12, emm62, emm41, emm1, emm9, emm14, emm4, emm19, emm5, emm18, emm13, emm6, emm22, emm26, emm11, emm15, emm29, emm27, emm76, emm75.

Figure 2-C. The 25 most common emm types contributing to invasive disease in the Middle East: there were a total of 59 emm types.

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The 25 most common emm types contributing to invasive disease in Pacific Island Countries / Indigenous Australians

Fig 2-D: The 25 most common emm types contributing to invasive disease in Pacific Island Countries/Indigenous Australians: there were a total of 75 emm types. Emm18, emm8, emm114, emm1, emm75, stNS554, emm89, emm22, emm58, emm11, emm118, emm91, emm28, emm100, emm108, emm14, emm73, emm81, emm56, emm104. Emm33, emm116, emm70, emm49, st854.

Figure 2-D. The 25 most common emm types contributing to invasive disease in Pacific Island Countries/Indigenous Australians: there were a total of 75 emm types.

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The 25 most common emm types contributing to invasive disease in the Established Market Economy countries

Fig 2-E:  The 25 most common emm types contributing to invasive disease in the Established Market Economy countries: there were a total of 148 emm types. Emm1, emm28, emm3, emm12, emm89, emm4, nontypeable, emm6, emm77, emm11, emm22, emm75, emm87, emm81, emm2, emm5, emm82, emm83, emm49. Emm73, emm18, emm114, emm44, emm58, emm78.

Figure 2-E. The 25 most common emm types contributing to invasive disease in the Established Market Economy countries: there were a total of 148 emm types.

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The 25 most common emm types contributing to pharyngeal disease in Africa

Fig 2-F:  The 25 most common emm types contributing to pharyngeal disease in Africa: there were a total of 79 emm types. Emm75, emm12, emm3, emm1, st463, stt2, emm5, emm25, emm18, emm71, emm74, emm9, emm75, st3757, emm8, emm81, emm22, emm30, emm43, emm44, emm106, emm29, emm28, st1731, emm6.

Figure 2-F. The 25 most common emm types contributing to pharyngeal disease in Africa: there were a total of 79 emm types.

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The 25 most common emm types contributing to pharyngeal disease in Asia

Fig 2-G:  The 25 most common emm types contributing to pharyngeal disease in Asia: there were a total of 70 emm types.  Emm44, emm12, emm75, emm1, emm6, nontypeable, emm77, emm22, emm71, emm81, emm11, emm49, emm3, emm5, emm18, emm92, emm74, emm28, emm69, emm79, emm82, emm118, st854, emm73, emm25.

Figure 2-G. The 25 most common emm types contributing to pharyngeal disease in Asia: there were a total of 70 emm types.

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The 25 most common emm types contributing to pharyngeal disease in Latin America

Fig 2-H:  The 25 most common emm types contributing to pharyngeal disease in Latin America: there were a total of 49 emm types.  Emm1, emm12, emm3, emm22, emm6, emm75, emm4, emm77, emm9, emm5, emm89, emm18, emm92, emm53, emm28, emm87, nontypeable, emm58, st1815, emm8, emm11, emm41 emm49, emm78.

Figure 2-H. The 25 most common emm types contributing to pharyngeal disease in Latin America: there were a total of 49 emm types.

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The 23 most common emm types contributing to pharyngeal disease in the Middle East

Fig 2-I: The 23 most common emm types contributing to pharyngeal disease in the Middle East: there were a total of 23 emm types.  Nontypeable, emm1, emm12, emm4, emm6, emm28, emm2, emm5, emm3, emm33, emm22, emm75, emm76, emm14, emm49, M58/75, emm58, emm77, emm18, emm60, emm15, emm9, emm23.

Figure 2-I. The 23 most common emm types contributing to pharyngeal disease in the Middle East: there were a total of 23 emm types.

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The 25 most common emm types contributing to pharyngeal disease in Pacific Island Countries / Indigenous Australians

Fig 2-J: The 25 most common emm types contributing to pharyngeal disease in Pacific Island Countries/Indigenous Australians: there were a total of 65 emm types. Emm55, emm11, emm1, emm1, emm22, emm103, emm58, emm44, emm78, stNS1033, emm755, st2904, emm25, emm33, emm105, emm91, stNS554, emm92, emm75, emm101, st6030, emm123, emm1-2.3, emm118, emm100.

Figure 2-J. The 25 most common emm types contributing to pharyngeal disease in Pacific Island Countries/Indigenous Australians: there were a total of 65 emm types.

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The 25 most common emm types contributing to pharyngeal disease in the Established Market Economy countries

Fig 2-K: The 25 most common emm types contributing to pharyngeal disease in the Established Market Economy countries: there were a total of 80 emm types.  Emm12, emm1, emm4, emm28, emm3, emm6, emm2, emm75, emm77, emm89, emm22, emm11, nontypeable, emm5, emm44, emm118, st1815, emm87, emm58, emm9, emm49, emm53, NZ1437, emm75, emm78.

Figure 2-K. The 25 most common emm types contributing to pharyngeal disease in the Established Market Economy countries: there were a total of 80 emm types.

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The 25 most common emm types contributing to skin disease in Africa

Fig 2-L: The 25 most common emm types contributing to skin disease in Africa: there were a total of 32 emm types. Emm80, emm100, st62, emm28, emm74, emm99, emm77, emm112, emm103, st1731, emm25, emm65, st1211, stG1750, emm102, emm22, st12917, st794, emm44, st1207, st5, emm1, emm43, emm9, st212.

Figure 2-L. The 25 most common emm types contributing to skin disease in Africa: there were a total of 32 emm types.

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The 25 most common emm types contributing to skin disease in Asia

Fig 2-M:  Figure 2-M. The 25 most common emm types contributing to skin disease in Asia: there were a total of 27 emm types. Emm1, emm2, emm44, emm100, emm71, emm77, st21470, emm53, emm122, emm85, emm89, st6030, emm103, emm56, emm57, emm68, emm70, emm102, emm65, emm43, emm78, emm25, emm63, emm82, emm11

Figure 2-M. The 25 most common emm types contributing to skin disease in Asia: there were a total of 27 emm types.

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The 25 most common emm types contributing to skin disease in Latin America

Fig 2-N: The 25 most common emm types contributing to skin disease in Latin America: there were a total of 34 emm types. Emm83, emm53, emm33, st2940, emm58, emm59, emm92, emm8, emm74, emm86, emm1, emm73, emm44, emm49, emm43, emm82, emm64, emm80, emm6, emm63, emm94, st204, emm22, emm66, emm28.

Figure 2-N. The 25 most common emm types contributing to skin disease in Latin America: there were a total of 34 emm types.

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The 25 most common emm types contributing to skin disease in Pacific Island Countries / Indigenous Australians

Fig 2-O: The 25 most common emm types contributing to skin disease in Pacific Island Countries/Indigenous Australians: there were a total of 73 emm types. Nontypeable, emm55, emm70, emm33, M53/80, emm25, emm11, emm93, emm76, emm73, emm44, emm103, emm69, emm100, emm56, emm91, emm89, emm71. stNS1033, emm82, emm53, emm39, st854, emm52, emm28.

Figure 2-O. The 25 most common emm types contributing to skin disease in Pacific Island Countries/Indigenous Australians: there were a total of 73 emm types.

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The 25 most common emm types contributing to skin disease in the Established Market Economy countries

Fig 2-P: The 25 most common emm types contributing to skin disease in the Established Market Economy countries: there were a total of 37 emm types. Emm53, emm81, emm28, emm4, emm12, emm49, emm1, emm89, emm80, NZ1437, emm75, emm92, emm58, emm57, emm77, emm52, emm60, emm3, emm87, emm13, emm55, emm68, emmm66, emm11, emm6.

Figure 2-P. The 25 most common emm types contributing to skin disease in the Established Market Economy countries: there were a total of 37 emm types.

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Information compiled by Dr. Andrew Steer and Dr. Irwin Law, Centre for International Child Health, University of Melbourne, Melbourne, Australia.


Proportions of the most common emm types among invasive U.S. isolates (2003-2004)
PDF [16 KB] | PowerPoint slide [55 KB]

Inquiries about this topic should be directed to Bernard Beall (404-639-1237  BBeall@cdc.gov ).

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