The majority of scarlet fever-associated lineages contained the unifying characteristic of 2 important mobile genetic elements: toxin-harboring prophages encoding streptococcal superantigens SSA and SpeC, and the DNase Spd1 (e.g., ΦHKU.vir), and integrative and conjugative elements (ICEs) encoding multidrug resistance to tetracycline and macrolides (e.g., ICE-emm12) [9,12]. The gene discussed is HOXD13; the disease is scarlet fever.