Epidemiological Trends of Racial Differences in Early- and Late-onset Group B Streptococcus Disease in Tennessee

Abstract

Background The rates of early-onset Group B Streptococcus (GBS) disease (EOGBS) have declined since the implementation of universal screening and intrapartum antibiotic prophylaxis guidelines but late-onset (LOGBS) rates remain unchanged. Racial differences in GBS disease rates have been previously documented with Black infants having higher rates of EOGBS and LOGBS, but it is not known if these have persisted. Therefore, we sought to determine the differences of EOGBS and LOGBS disease by race over the past decade in Tennessee. Methods This study used active population-based and laboratory-based surveillance data for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties across Tennessee. We included infants younger than 90 days and who had invasive GBS disease between 2009-2018. Results A total of 356 GBS cases were included, with 60% having LOGBS. EOGBS and LOGBS had decreasing temporal trends over the study period. Overall, there were no changes of temporal trend noted in the rates of EOGBS and LOGBS among White race. However, Black infants had a significantly decreasing EOGBS and LOGBS temporal trends, [(RR=0.87, 95% CI= [0.79, 0.96], P-value=0.007), (RR= 0.90, 95% CI= [0.84, 0.97], P-value=0.003)], respectively. Conclusions Years after the successful implementation of the universal screening guidelines, our data revealed an overall decrease in LOGBS rates, primarily driven by changes among infants of Black race. More studies are needed to characterize the racial disparities in GBS rates, and factors driving them. Prevention measures such as vaccination are needed to have a further impact on disease rates.

Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis

“…A summary of the methodology, characteristics of findings, presence of racial disparity, quality appraisal, and country of study is presented in Table 3 . All of the reviewed studies employed a quantitative methodology [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and used surveillance data collected from electronic health record systems. The studies were conducted from January 2016 to December 2022.…”

“…Fourteen studies (70%) were conducted among children between the ages of 0 and 17 years, one study [ 14 ] was conducted among children between the ages of 0 and 4 years, one study [ 16 ] was conducted among children between the ages of 0 and 5 years, one study [ 17 ] was conducted among adolescents between the ages 12 and 17, one study [ 25 ] was conducted among infants between the ages of 0 and 2 months, and two studies [ 24 ] were conducted among children and adults. However, only data reported on children within the studies [ 24 , 28 ] were used in this review.…”

“…However, a study conducted by Hamdan et al [ 25 ] reported mixed findings in terms of the presence of racial disparities in the rate of occurrence of streptococcus, with no disparity present in the rate of occurrence of early-onset Group B streptococcus and racial disparity associated with the occurrence rate of late-onset Group B streptococcus, with Blacks or African Americans carrying the burden for this infection (Blacks/African Americans vs. Whites: RR, 1.55; 95% CI, 1.24–1.93; p < 0.001).…”

“…Whites: RR, 1.55; 95% CI, 1.24–1.93; p < 0.001). The mixed findings of this study may be a result of newly enforced public health interventions for early-onset Group B streptococcus, such as universal screening [ 25 ].…”

Understanding Factors in Group B Streptococcus Late-Onset Disease

“…The LOGBS rates among Black infants have shown a reduced temporal trend (RR 0.90, 95% CI 0.84–0.97, p=0.003); however, no changes were observed among White infants (RR 0.99, 95% CI 0.92–1.07, p=0.768). 66 …”