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Clin Infect Dis. 2019 Aug 16;69(5):877-883. doi: 10.1093/cid/ciy1143.

The Path to Group A Streptococcus Vaccines: World Health Organization Research and Development Technology Roadmap and Preferred Product Characteristics.

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Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
International Vaccine Institute, Seoul, Republic of Korea.
Molecular Bacteriology Laboratory, Université Libre de Bruxelles.
Department of Pediatrics, Academic Children Hospital Queen Fabiola, Brussels, Belgium.
Tropical Diseases Research Group, Murdoch Children's Research Institute.
Centre for International Child Health, University of Melbourne, Australia.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Paediatrics, University of Melbourne.
Royal Children's Hospital, Melbourne.
Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Australia.
PATH, Seattle, Washington.


Group A Streptococcus (GAS) infections result in a considerable underappreciated burden of acute and chronic disease globally. A 2018 World Health Assembly resolution calls for better control and prevention. Providing guidance on global health research needs is an important World Health Organization (WHO) activity, influencing prioritization of investments. Here, the role, status, and directions in GAS vaccines research are discussed. WHO preferred product characteristics and a research and development technology roadmap, briefly presented, offer an actionable framework for vaccine development to regulatory and policy decision making, availability, and use. GAS vaccines should be considered for global prevention of the range of clinical manifestations and associated antibiotic use. Impediments related to antigen diversity, safety concerns, and the difficulty to establish vaccine efficacy against rheumatic heart disease are discussed. Demonstration of vaccine efficacy against pharyngitis and skin infections constitutes a key near-term strategic goal. Investments and collaborative partnerships to diversify and advance vaccine candidates are needed.


group A Streptococcus; pharyngitis; rheumatic heart disease; vaccine

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