Maternal Immunization With an Investigational Trivalent Group B Streptococcal Vaccine

Donders, Gilbert; Halperin, Scott A.; Devlieger, Roland; Baker, Sherryl; Forte, Pietro; Wittke, Frederick; Slobod, Karen S.; Dull, Peter

doi:10.1097/aog.0000000000001190

Cited by 81 publications

(69 citation statements)

References 18 publications

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“…Current recommendations focus on maternal GBS screening and intrapartum prophylactic antibiotics to prevent early-onset neonatal infection [3]. 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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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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“…10 In this setting, understanding the implications of routine GBS screening on not only neonatal health but also maternal outcomes is warranted. 11 We assessed whether maternal GBS colonization was associated with chorioamnionitis, as well as other markers of maternal peripartum infection, using data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Consortium on Safe Labor (CSL) study. In contrast to historical data, prior to routine screening suggested an increased risk of peripartum infection associated with GBS colonization, as we hypothesized that maternal GBS colonization would not be associated with maternal peripartum infection in an era of routine screening.…”

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confidence: 99%

Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis?

et al. 2020

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Objective This study aimed to assess whether colonization with group B streptococcus (GBS) is associated with maternal peripartum infection in an era of routine prophylaxis. Study Design This study presented a secondary analysis of women delivering ≥37 weeks who underwent a trial of labor from the U.S. Consortium on Safe Labor (CSL) study. The exposure was maternal GBS colonization and the outcome was a diagnosis of chorioamnionitis, and secondarily, analyses were restricted to deliveries not admitted in labor and measures of postpartum infection (postpartum fever, endometritis, and surgical site infection). Logistic regression with generalized estimating equations was used accounting for within-woman correlations. Models adjusted for maternal age, parity, race, prepregnancy body mass index, pregestational diabetes, insurance status, study site/region, year of delivery, number of vaginal exams from admission to delivery, and time (in hours) from admission to delivery. Results Among 170,804 assessed women, 33,877 (19.8%) were colonized with GBS and 5,172 (3.0%) were diagnosed with chorioamnionitis. While the frequency of GBS colonization did not vary by chorioamnionitis status (3.0% in both groups), in multivariable analyses, GBS colonization was associated with slightly lower odds of chorioamnionitis (adjusted odds ratio [AOR]: 0.89; 95% confidence interval [CI]: 0.83–0.96). In secondary analyses, this association held regardless of spontaneous labor on admission; and the odds of postpartum infectious outcomes were not higher with GBS colonization. Conclusion In contrast to historical data, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis. Key Points

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“…This finding has implications for the development of vaccines against GBS infection. nonpregnant and pregnant women, and elicited maternal antibodies were efficiently transferred to neonates (21)(22)(23).…”

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confidence: 99%

Structure of a protective epitope of group BStreptococcustype III capsular polysaccharide

Carboni¹,

Adamo²,

Fabbrini³

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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Despite substantial progress in the prevention of group B Streptococcus (GBS) disease with the introduction of intrapartum antibiotic prophylaxis, this pathogen remains a leading cause of neonatal infection. Capsular polysaccharide conjugate vaccines have been tested in phase I/II clinical studies, showing promise for further development. Mapping of epitopes recognized by protective antibodies is crucial for understanding the mechanism of action of vaccines and for enabling antigen design. In this study, we report the structure of the epitope recognized by a monoclonal antibody with opsonophagocytic activity and representative of the protective response against type III GBS polysaccharide. The structure and the atomic-level interactions were determined by saturation transfer difference (STD)-NMR and X-ray crystallography using oligosaccharides obtained by synthetic and depolymerization procedures. The GBS PSIII epitope is made by six sugars. Four of them derive from two adjacent repeating units of the PSIII backbone and two of them from the branched galactose–sialic acid disaccharide contained in this sequence. The sialic acid residue establishes direct binding interactions with the functional antibody. The crystal structure provides insight into the molecular basis of antibody–carbohydrate interactions and confirms that the conformational epitope is not required for antigen recognition. Understanding the structural basis of immune recognition of capsular polysaccharide epitopes can aid in the design of novel glycoconjugate vaccines.

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Maternal Immunization With an Investigational Trivalent Group B Streptococcal Vaccine

Abstract: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01446289.

Cited by 81 publications

References 18 publications

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

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

Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis?

Structure of a protective epitope of group BStreptococcustype III capsular polysaccharide

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