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Age Influences the emm Type Distribution of Pediatric Group A Streptococcal Pharyngeal Isolates

Jaggi, Preeti MD*; Tanz, Robert R. MD*; Beall, Bernard PhD; Shulman, Stanford T. MD*

The Pediatric Infectious Disease Journal: December 2005 - Volume 24 - Issue 12 - p 1089-1092
doi: 10.1097/01.inf.0000190023.89759.96
Original Studies

Background: emm types 12, 1, 28, 3, 4, 2 and 6 (in that order) are the types most commonly associated with uncomplicated group A streptococcal (GAS) pharyngitis in the United States, together accounting for ∼78% of isolates.

Objective: To determine whether the distribution of common pharyngeal group A streptococcal GAS types differs at various ages throughout childhood.

Study Design: We emm typed 3356 GAS isolates collected from the United States and Canada during 3 streptococcal seasons (2000-2003). Variations in prevalence by age for the 7 most prevalent emm types and the “uncommon” category (all types accounting for <5% of the total number of isolates) were analyzed and assessed for significance by χ2.

Results: The proportion of uncommon isolates increased significantly with increasing age from 18% in group 1 to 37% in group 4 (P = 0.001). We found a significant decrease in the proportion of the common pharyngeal emm types, specifically emm 12 and emm 4 type isolates, with increasing age (P = 0.001 and P = 0.003, respectively); there was no significant decline in the prevalence of other common pharyngeal types (emm 1, 2, 3, 6 and 28) with increasing age.

Conclusion: Age-related changes in emm type distribution of pharyngeal GAS are present in childhood; these changes may reflect acquisition of immunity to more common types as a consequence of exposure early in life, but this remains to be demonstrated.

From the *Children's Memorial Hospital, Chicago, IL; and †Centers for Disease Control and Prevention, Atlanta, GA

Accepted for publication July 12, 2005.

Supported by a grant from IDBiomedical.

Address for reprints: Preeti Jaggi, MD, Children's Memorial Hospital, 2300 Children's Plaza, Box 20, Chicago, IL 60614. Fax 773-880-8226; E-mail

© 2005 Lippincott Williams & Wilkins, Inc.