Streptococcus pyogenes, also known as Group A Streptococcus (GAS), is a Gram-positive human-exclusive pathogen, responsible for more than 500 000 deaths annually worldwide. Upon infection, GAS commonly triggers mild symptoms such as pharyngitis, pyoderma and fever. However, recurrent infections or prolonged exposure to GAS might lead to life-threatening conditions. Necrotizing fasciitis, streptococcal toxic shock syndrome and post-immune mediated diseases, such as poststreptococcal glomerulonephritis, acute rheumatic fever and rheumatic heart disease, contribute to very high mortality rates in non-industrialized countries. Though an initial reduction in GAS infections was observed in high-income countries, global outbreaks of GAS, causing rheumatic fever and acute poststreptococcal glomerulonephritis, have been reported over the last decade. At the same time, our understanding of GAS pathogenesis and transmission has vastly increased, with detailed insight into the various stages of infection, beginning with adhesion, colonization and evasion of the host immune system. Despite deeper knowledge of the impact of GAS on the human body, the development of a successful vaccine for prophylaxis of GAS remains outstanding. In this review, we discuss the challenges involved in identifying a universal GAS vaccine and describe several potential vaccine candidates that we believe warrant pursuit.

化脓性链球菌也称为 A 组链球菌 (GAS)，是一种革兰氏阳性人类独有病原体，每年导致全球超过 50 万人死亡。感染后，GAS 通常会引发轻度症状，例如咽炎、脓皮病和发烧。然而，反复感染或长期接触 GAS 可能会导致危及生命的情况。坏死性筋膜炎、链球菌中毒性休克综合征和免疫后介导的疾病，如链球菌感染后肾小球肾炎、急性风湿热和风湿性心脏病，导致非工业化国家的死亡率非常高。虽然在高收入国家观察到 GAS 感染的初步减少，但在过去十年中报告了导致风湿热和急性链球菌感染后肾小球肾炎的 GAS 全球暴发。同时，我们对 GAS 发病机制和传播的了解大大增加，详细了解感染的各个阶段，从宿主免疫系统的粘附、定植和逃避开始。尽管对 GAS 对人体的影响有了更深入的了解，但开发用于预防 GAS 的成功疫苗仍然很突出。在这篇综述中，我们讨论了确定通用 GAS 疫苗所涉及的挑战，并描述了我们认为值得追求的几种潜在候选疫苗。用于预防 GAS 的成功疫苗的开发仍然悬而未决。在这篇综述中，我们讨论了确定通用 GAS 疫苗所涉及的挑战，并描述了我们认为值得追求的几种潜在候选疫苗。用于预防 GAS 的成功疫苗的开发仍然悬而未决。在这篇综述中，我们讨论了确定通用 GAS 疫苗所涉及的挑战，并描述了我们认为值得追求的几种潜在候选疫苗。