G292(P) Estimates of the burden of group b streptococcal disease worldwide for pregnant women, stillbirths and children

Abstract

BackgroundWe aimed to estimate, for the first time, the global burden of Group B Streptococcus (GBS), with regards to invasive disease in infants, as well as in pregnant and postpartum women, and fetal infection/stillbirth. Intrapartum antibiotic prophylaxis (IAP) is currently used for prevention of early onset infant disease in high-income contexts, but is difficult to implement globally, and may contribute to antimicrobial resistance. Maternal GBS vaccines are in development.MethodsFor 2015 live births, we used data from systematic reviews and meta-analyses (presented in separate papers in this GBS supplement) and a compartmental model to estimate:exposure to maternal GBS colonisation,cases of infant invasive GBS disease,deaths, anddisabilities.We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy (NE). We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated.Worldwide in 2015, we estimated 2 05 000 (uncertainty range [UR], 101000–327000) infants with early-onset disease and 1 14 000 (UR, 44000–326000) with late-onset disease, of whom a minimum of 7000 (UR, 0–19000) presented with neonatal encephalopathy. There were 90 000 (UR, 36000–169000) deaths in infants<3 months age, and, at least 10 000 (UR, 3000–27000) children with disability each year. There were 33 000 (UR, 13000–52000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12000–104000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 1 07 000 (UR, 20000–198000) stillbirths and infant deaths.ConclusionsOur conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 4 09 000 (UR, 144000–573000) maternal/fetal/infant cases and 1 47 000 (UR, 47000–273000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.AcknowledgementAdditional authors include H Blencowe (1), S Cousens (1), CJ Baker, L Bartlett, C Cutland, MGGravett, PT Heath, M Ip, K Le Doare, SA Madhi, CE Rubens, SK Saha, SJ Schrag, A Sobanjo-ter Meulen, J Vekemans

Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study

“…Pregnancy associated group B streptococcus (GBS) is a well-established cause of significant neonatal morbidity and mortality [1]. Consequently, extensive efforts are directed towards the prevention of this devastating infection [2].…”

Clinical and Molecular Epidemiology of Invasive Group BStreptococcusDisease among Infants, China

“…Invasive group B Streptococcus (GBS), the gram-positive Streptococcus agalactiae bacterium, is a leading cause of illness and death among infants, including those in high-income countries. After a series of systematic reviews and a meta-analysis, a compartmental-model simulation estimated ≈319,000 GBS cases, including ≈90,000 deaths, worldwide in 2015 ( 2 ). Furthermore, conservative estimates for GBS-associated stillbirths were 57,000, and 33,000 invasive disease episodes occurred in pregnant and peripartum women ( 2 ).…”

“…After a series of systematic reviews and a meta-analysis, a compartmental-model simulation estimated ≈319,000 GBS cases, including ≈90,000 deaths, worldwide in 2015 ( 2 ). Furthermore, conservative estimates for GBS-associated stillbirths were 57,000, and 33,000 invasive disease episodes occurred in pregnant and peripartum women ( 2 ). The overall global incidence of invasive GBS disease among infants < 3 months of age in 2015 was estimated to be 0.49 (95% CI 0.43–0.56) cases/1,000 live births; the case-fatality rate was estimated at 8.4% (95% CI 6.6%–10.2%) ( 3 ).…”

“…Two studies from China estimated the GBS incidence rate was 0.18–0.32 cases/1,000 live births ( 3 ). Nevertheless, China had the second highest absolute number of GBS cases among infants globally with 25,000 (uncertainty range 0–59,000) ( 2 ). …”

“…Systematic reviews noted the paucity of data on GBS from Asia, including China, as a major data gap ( 2 – 6 ), highlighting the need for prospective population-based studies. A previous study by our group reported a GBS incidence rate of 0.55 (95% CI 0.44–0.69) cases/1,000 live births in 3 hospitals in the Guangdong Province of southern China during 2011–2014 ( 7 ).…”