Advancing Group A Streptococcus vaccines: barriers, models, and the path to rheumatic fever prevention

Group A Streptococcus (GAS; Streptococcus pyogenes) remains a leading global cause of infectious and post-infectious disease and a substantial annual burden of pharyngitis, invasive disease, and immune-mediated sequelae.1 Acute rheumatic fever (ARF) and its chronic sequelae, rheumatic heart disease (RHD), disproportionately affect children and young adults in low- and middle-income countries and marginalised populations in high-income settings.2 To date, no licensed vaccine against GAS is available, and diagnostic tools for ARF remain scarcely available.