Surveillance and characterization of invasive group A streptococcal coinfection with viral respiratory infections.

Group A Streptococcus (GAS) is a bacterial infection caused by Streptococcus pyogenes. Infection can cause strep throat in minor cases, and if sterile sites (e.g., blood) are infected, it can lead to invasive GAS (iGAS) (e.g septic shock). The emm gene defines the different emm serotypes in iGAS and is a major virulence factor during infection.In Alberta, iGAS infections have risen from 11 per 100,00 in 2022 to 19 per 100,000 in 2023. This increase is mainly attributed to emm-types emm1 and emm12 and is further complicated by increased iGAS and Viral Respiratory Infections (VRI) coinfection cases being observed by the Alberta Public Health Laboratory (ProvLab). It is therefore of great importance to identify which emm-types are associated with iGAS-VRI coinfection and to understand the underlying genetic factors at play.By looking at all iGAS infections and iGAS-VRI coinfections in Alberta from 2018 to 2023, we can identify any associations between specific emm-type and VRIs. In addition to this, three time periods (pre-COVID, during COVID, and post- COVID) will be looked at to find any differences in the distribution of emm-types and VRI coinfections in relation to the COVID-19 pandemic. Whole genome sequencing using Illumina will be conducted on all emm-types to align core genomes and identify any single nucleotide polymorphisms and changes to virulence factors in relation to iGAS-VRI coinfection and iGAS from 2018 to 2023.Gaining insights on the emm-types associated with VRIs during coinfection will provide a greater understanding of the rise in emm1 and emm12 in Alberta and identify if it is associated with iGAS-VRI coinfection. Additionally, these data can be used by healthcare providers to improve clinical practices for iGAS and iGAS/VRI coinfections. .