Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Abstract

Objective We describe cases of invasive group A Streptococcus (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28 days of birth and investigation of clusters in maternity units.Design Cross-sectional retrospective study. Setting and population Notified confirmed iGAS cases in either mothers or neonates with onset within 28 days of birth in London and the South East of England between 2010 and 2016Method Review of public health records of notified cases.Main outcome measures Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6 months.Results We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28 days postpartum was 109 (95% CI 90-127) compared with 1.3 in other females aged 15-44. For neonates the incidence was 1.5 (95% CI 9-23). The median onset time was 2 days postpartum [interquartile range (IQR) 0-5 days] for mothers and 12 days (IQR 7-15 days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued.Conclusions iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved.

Streptococcus pyogenes infects human endometrium by limiting its immune response

“…Our molecular decryption of GAS infection of the human decidua supports epidemiological conclusions for the necessity of maintaining and even increasing prophylactic measures (2,66) and the need to develop a vaccine to prevent life-threatening GAS infections such as puerperal fevers.…”

Out-of-season increase of puerperal fever with group A Streptococcus infection: a case–control study, Netherlands, July to August 2018

“…Women in the first 30 days of puerperium have a 20-fold increased risk of invasive GAS infection compared with non-pregnant women of reproductive age [8,9]. Invasive GAS infections in puerperium often present as endometritis or sepsis with a genital focus, but can also manifest at a non-genital site, and as GAS bacteraemia without a clear focus [8,10].…”

“…The source of invasive GAS infection in puerperium is often the woman's throat or that of a close contact [11]. However, healthcare workers carrying GAS are also a possible source, and maternity ward clusters of puerperal GAS infections occur occasionally [9].…”

Neonatal Group A Streptococcus Meningitis. Case Report and Literature Review

“…It should be noted that this suggested mode of transmission from a close dweller with symptomatic GAS pharyngitis has been described in two past cases reviewed in this work [2,20], but these did not pursue microbiological evidence for In our case, earlier recognition of the mother's symptoms may have enabled prompt maternal antibiotic treatment and brought into consideration isolation of the neonate from the mother. Leonard et al [21] recently published a study on severe GAS infections in mothers and their newborns. In this study of 134 maternal and 21 neonatal invasive GAS infections, Leonard et al found that the median onset time for infection was 2 days postpartum for mothers and 12 days postpartum for neonates.…”