Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina

Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden

“…Our analyses have strengths and limitations. We were able to advance the previous GBS global burden estimates, 7 particularly with new studies on NDI from either high-income countries or low-income and middle-income countries, 29 which were funded as a result of the gaps shown in the first study. 15 The Bayesian approach has many advantages compared with the previous estimation approach, including the propagation of uncertainty for several parameter estimates, although, as mentioned earlier, a few of these parameters were assumed to be fixed.…”

“…One meta-analysis of studies performed in low-income and middle-income countries, 40 for example, estimated a lower prevalence of NDI in the general population in some settings, whereas other data, collected using sensitive tools for NDI assessment, suggest a higher baseline risk of moderate or severe NDI than the baseline risk estimated in the Denmark study (1–25% in studies with more than ten participants. 29 Another limitation of our analysis is that different studies recruited children at different ages and used different NDI assessment tools or epidemiological designs, which might partly explain the substantial between-study variability in risk ( appendix pp 29–32 ). Furthermore, unlike the previous estimates, we did not quantify neonatal encephalopathy with GBS to avoid double counting.…”

“…The sample sizes of some of the studies, in particular the studies on NDI outcomes after GBS meningitis in low-income and middle-income countries, were small, which highlights the difficulty in performing these studies in some settings and the need to improve surveillance to identify those who recover from iGBS. 29 Intrapartum antibiotic prophylaxis coverage data are also few, and our analysis is informed by a literature review with data for 92 countries. Currently, our estimates do not incorporate uncertainty for this variable; but a sensitivity analysis ( appendix pp 6–7 ) indicates how the overestimation or underestimation of intrapartum antibiotic prophylaxis coverage might have influenced estimation.…”

“…In this analysis, we estimated the risk of moderate and severe impairments, which is more likely to be consistent across settings and study designs compared with milder NDI types; in the appendix (pp 15–16 ), we present the results of analyses that also considered mild NDIs. For meningitis, we used studies reviewed in 2017, 14 novel data from a national cohort in Denmark (which included children with outcome data available at the age of 10 years), 15 and reanalysis of data from a multicentre observational study 29 performed in Argentina, India, Mozambique, Kenya, and South Africa including all meningitis cases, irrespective of age (4–17 participants in each centre, with a total of 38 participants); that study was performed as part of this research project. For GBS sepsis, we used data from the same study in Denmark (805 children with data at the age of 10 years) and four smaller studies (4–61 participants in each study, with a total of 109 participants), also reviewed in a systematic review by Kohli-Lynch and colleagues, 14 for high-income countries; for low-income and middle-income countries, data from the aforementioned multicentre study were used (22–31 participants in each centre, with a total of 108 participants) in a separate meta-analysis.…”

Maternal immunisation against Group B Streptococcus: a global analysis of health impact and cost-effectiveness

“…Furthermore, survivors of iGBS are at risk of long-term neurological sequelae with an estimated 37,100 (14,600 – 96,200) surviving infants developing moderate or severe neuro-developmental impairment (NDI). 1,4 Maternal colonisation with GBS is also an important cause of adverse pregnancy outcomes with an estimated 46,000 (20,000 – 111,000) GBS stillbirths and is potentially linked with 518,000 (36,000 – 1,142,000) excess preterm births.…”