Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Hall, Jennifer; Adams, Nadine Hack; Bartlett, Linda; Seale, Anna C.; Lamagni, Theresa; Bianchi-Jassir, Fiorella; Lawn, Joy E; Baker, Carol J.; Cutland, Clare; Heath, Paul T; Ip, Margaret; Doare, Kirsty Le; Madhi, Shabir A.; Rubens, Craig E.; Saha, Samir K.; Schrag, Stephanie J.; Meulen, Ajoke Sobanjo-ter; Vekemans, Johan; Gravett, Michael G.

doi:10.1093/cid/cix660

Cited by 101 publications

(111 citation statements)

References 51 publications

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“…The asymptomatic colonization in some yet invasive disease progression in others emphasizes the complexity of the host-GBS interaction. Maternal colonization by serotype Ia is seen globally (24), and it is the most prevalent serotype in maternal disease, according to a limited meta-analysis (including only the United States, United Kingdom, and France) (26). Regarding neonatal disease, a previous meta-analysis found Ia to be the most frequent serotype contributing to EOD; however, this global estimate lacked data from Asia (27).…”

Section: Serotypingmentioning

confidence: 99%

Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets

2018

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SUMMARY, or group B streptococcus (GBS), is a major neonatal pathogen. Recent data have elucidated the global prevalence of maternal and neonatal colonization, but gaps still remain in the epidemiology of this species. A number of phenotypic and genotypic classifications can be used to identify the diversity of GBS strains, and some are more discriminatory than others. This review explores the main schemes used for GBS epidemiology and further details the targets for epidemiological surveillance. Current screening practices across the world provide a unique opportunity to gain detailed information on maternal colonizing strains and neonatal disease-causing strains, which is vital for monitoring and therapeutics, if sufficient detail can be extracted. Deciphering which isolates are circulating within specific populations and recording targets within invasive strains are crucial steps in monitoring the implementation of therapeutics, such as vaccines, as well as developing novel therapies against prevalent GBS strains. Having a detailed understanding of global GBS epidemiology will prove invaluable for understanding the pathogenesis of this organism and equipping future prevention strategies for success.

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Section: Serotypingmentioning

confidence: 99%

Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets

2018

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“…[1][2][3] Infant invasive GBS disease is classified as early-onset disease (EOD) if it occurs during the first 6 days of life or late-onset disease (LOD) if it develops 7 or more days after birth. The worldwide burden of infant and maternal GBS disease is substantial, [4][5][6][7][8][9][10][11][12][13] and efforts are under-way to develop vaccines as a preventive measure to replace or supplement antenatal screening and intrapartum antibiotics effective against early but not late-onset disease. [14][15][16][17] EOD arises from vertical transmission from a GBS colonized mother to her baby during or just before birth, with clinical signs occurring within 48 h in more than 90% of cases.…”

Section: Introductionmentioning

confidence: 99%

Hospital clusters of invasive Group B Streptococcal disease: A systematic review

Collin

Lamb

Jauneikaite

et al. 2019

Journal of Infection

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Group B streptococcal disease Adult Neonatal Outbreak Cluster Healthcare-associated infection Systematic review s u m m a r y Objectives: To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals.Methods: Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297. Results: Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset ( < 7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant ( n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. Conclusions: Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics.

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“…Recent renewed efforts to prevent both early-and late-onset neonatal infection have focused on maternal vaccination against GBS in order to provide neonatal benefit [4,5]. Conversely, few systematic studies exist regarding the potential maternal or pregnancy-related benefits of vaccination [6].…”

Section: Introductionmentioning

confidence: 99%

Group B streptococcus (GBS) colonization and disease among pregnant women: a historical cohort study

Edwards

Wynn

Watson

et al. 2017

American Journal of Obstetrics and Gynecology

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Background. Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease. Methods. A single center historical cohort study of all births between 2003 and 2015 was performed. Data was collected via electronic health record abstraction using an institutional specific tool. Descriptive statistics were performed regarding GBS status. Inferential statistics were performed comparing risk of adverse pregnancy outcomes in cohorts with and without GBS colonization as well as cohorts with GBS colonization and invasive GBS disease. Results. A total of 60,029 deliveries were included for analysis. Overall, 21.6% of the population was GBS colonized and 0.1% had invasive GBS disease. GBS colonization was associated with younger maternal age, Black race, non-Hispanic ethnicity, chronic hypertension, preexisting diabetes, and tobacco use (p<0.01). In the adjusted analyses, there was an increased risk of gestational diabetes (aRR 1.21, 95% CI 1.11-1.32) in colonized pregnancies and a decreased incidence of short cervix (aRR 0.64, 95% CI 0.52-0.79), chorioamnionitis (aRR 0.76, 95% CI 0.66-0.87), wound infection (aRR 0.75, 95% CI 0.64-0.88), and operative delivery (aRR 0.85, 95% CI 0.83-0.88). Conclusions. This modern-day large cohort of all births over a 12-year period demonstrates a GBS colonization rate of 21.6%. This data reflects a need to assess maternal and perinatal outcomes in addition to neonatal GBS sepsis rates to inform decisions regarding the utility of maternal vaccination.Hindawi

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Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

Abstract: From the limited data available, the incidence of maternal group B streptococcal (GBS) disease in developed countries appears lower than, but comparable to, the incidence of early-onset neonatal GBS disease. There are no published data from low- and middle-income contexts.

Cited by 101 publications

References 51 publications

Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets

Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets

Hospital clusters of invasive Group B Streptococcal disease: A systematic review

Group B streptococcus (GBS) colonization and disease among pregnant women: a historical cohort study

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