Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses

Seale, Anna C.; Blencowe, Hannah; Bianchi-Jassir, Fiorella; Embleton, Nicholas D.; Bassat, Quique; Ordi, Jaume; Menéndez, Clara; Cutland, Clare; Briner, Carmen; Berkley, James A.; Lawn, Joy E; Baker, Carol J.; Bartlett, Linda; Gravett, Michael G.; Heath, Paul T; Ip, Margaret; Doare, Kirsty Le; Rubens, Craig E.; Saha, Samir K.; Schrag, Stephanie J.; Meulen, Ajoke Sobanjo-ter; Vekemans, Johan; Madhi, Shabir A.

doi:10.1093/cid/cix585

Cited by 120 publications

(114 citation statements)

References 37 publications

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“…GBS is a common colonizer of the female genital tract during pregnancy. It has been associated with severe neonatal infections, and there have been few changes in mortality rates since 1990 [5]. Maternal colonization is a necessary condition for ascending fetal infection, stillbirth, and early onset of the disease in neonates, constituting a risk factor for late-onset disease [43,44].…”

Section: Discussionmentioning

confidence: 99%

Mucosal Vaccination with Lactococcus lactis-Secreting Surface Immunological Protein Induces Humoral and Cellular Immune Protection against Group B Streptococcus in a Murine Model

et al. 2020

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Group B Streptococcus (GBS) is the primary etiological agent of sepsis and meningitis in newborns and is associated with premature birth and stillbirth. The development of a licensed vaccine is one of the pending challenges for the World Health Organization. Previously, we showed that oral immunization with surface immune protein (SIP) decreases vaginal colonization of GBS and generates functional opsonizing antibodies, which was determined by opsonophagocytic assays (OPA) in vitro. We also showed that the protein has an adjuvant vaccine profile. Therefore, an oral vaccine based on SIP may be an attractive alternative to employ in the development of new vaccines against GBS. Lactococcus lactis is a highlighted oral vaccine probiotic inducer of the mucosal immune response. This bacterium could serve as an antigen-delivering vehicle for the development of an edible vaccine and has been used in clinical trials. In this study, we showed that an oral vaccine with a recombinant L. lactis strain secreting SIP from GBS (rL. lactis-SIP) can induce protective humoral and cellular immunity in an experimental model of GBS vaginal colonization in C57BL/6 mice. Mice immunized with rL. lactis-SIP were protected against clinical symptoms and bacterial colonization after GBS vaginal colonization. Our rL. lactis-SIP vaccine also induces an increase of immunoglobulin G (IgG) and immunoglobulin A (IgA) specifically against SIP. The adoptive transfer of serum from vaccinated mice to naïve mice generated protection against GBS vaginal colonization. Moreover, the rL. lactis-SIP strain induces the activation of SIP-specific T cells, which could decrease GBS vaginal colonization and generate protective antibodies when transferred to other mice. Our experimental observations strongly support the notion that rL. lactis-SIP induces protective humoral and cellular immunity and could be considered as a novel alternative in the development of vaccines for GBS.

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Section: Discussionmentioning

confidence: 99%

Mucosal Vaccination with Lactococcus lactis-Secreting Surface Immunological Protein Induces Humoral and Cellular Immune Protection against Group B Streptococcus in a Murine Model

et al. 2020

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“…This has been minimized through verifying the data by the study team before discharging the mother and newborn. Moreover, collecting of microbiological evidence of invasive GBS infection from a normally sterile site, such as fetal blood from the umbilical cord or from the heart, lung aspirate, cerebrospinal fluid or fetal tissues as recommended [ 42 ] were not done due to resource constraints. Moreover, immunologic and placenta investigations were also not possible in this setting.…”

Section: Discussionmentioning

confidence: 99%

Maternal group B Streptococcus recto vaginal colonization increases the odds of stillbirth: evidence from Eastern Ethiopia

Yadeta

Worku

Egata

et al. 2018

BMC Pregnancy Childbirth

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BackgroundGroup B Streptococcus (GBS) causes a significant number of stillbirths. Despite this, there is little documented information on the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Sub Saharan Africa. As such, this study was aimed at identifying the association between stillbirth and pregnant women’s GBS recto vaginal colonization in Eastern Ethiopia.MethodsA health facility-based cross-sectional study was conducted among 1688 pregnant women who came for delivery service in Harar town, Eastern Ethiopia between June to October in 2016. Data were collected using a pre-tested structured questionnaire and checklist (which utilize clinical record). Group B streptococcus positivity of the pregnant women was confirmed by culture of recto vaginal swab using selective media. The association between GBS colonization and stillbirth was examined using multivariable logistic regression analysis. A statistical significance was declared at p-value ≤0.05.ResultsOf the 1688 pregnant women who participated in the study, 144 had stillbirths, representing a prevalence of 8.53% [(95% CI: (7.19, 9.86)]. Group B Streptococcus colonization at birth was detected in 231 women (13.68%; 95% CI 12.04, 15.32). Of these 144 stillbirths 59 (40.97%) were from colonized mothers and 72(59.03%) were from non-colonized mothers. Of these 59 stillbirth from colonized mothers, 32(54.23%) were intrapartum stillbirth, 27(45.77%) were antepartum stillbirth occur before exposed to intrapartum antibiotic prophylaxis (IAP). After controlling for potential confounders, the odds of having a stillbirth were 8.93 times higher among recto vaginal GBS colonized pregnant women [AOR = 8.93; 95% CI; (5.47, 14.56)].ConclusionsThis study demonstrated a significant association between maternal recto vaginal GBS colonization and stillbirth. Efforts to reduce stillbirth need to consider prevention of GBS colonization among pregnant women. Maternal vaccination may provide a feasible strategy to reduce stillbirth due to GBS.

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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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Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses

Abstract: Group B Streptococcus (GBS) is associated with invasive disease in utero and stillbirth. We estimated that 1% of all stillbirths in developed countries and 4% in Africa were associated with GBS.

Cited by 120 publications

References 37 publications

Mucosal Vaccination with Lactococcus lactis-Secreting Surface Immunological Protein Induces Humoral and Cellular Immune Protection against Group B Streptococcus in a Murine Model

Mucosal Vaccination with Lactococcus lactis-Secreting Surface Immunological Protein Induces Humoral and Cellular Immune Protection against Group B Streptococcus in a Murine Model

Maternal group B Streptococcus recto vaginal colonization increases the odds of stillbirth: evidence from Eastern Ethiopia

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

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