Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – a narrative review (original) (raw)
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Journal of Tropical Pediatrics, 2022
Background: Group B Streptococcus (GBS or S. agalactiae) is a major cause of severe disease in neonates. In perinatal infections or early-onset disease (EOD), GBS is transmitted vertically to the newborn from the birth canal during labor and delivery. Limited information is available on the prevalence of GBS recto-vaginal colonization among pregnant women in Iran. Methods: We performed a systematic search by using different electronic databases including: Medline (via Pubmed), Embase, Web of Science, and Iranian Database. Meta-analysis was performed by Comprehensive Meta-Analysis (Biostat V2.2) software. Results: Of 250 articles published from January 2000 to September 2016, 25 studies which reported incidence of GBS colonization in pregnant women were included in this review. The meta-analyses showed that the prevalence of GBS colonization among Iranian pregnant women was 9.8% (95% confidence interval [95% CI] 7.9-12). Conclusion: The results of this study indicates that GBS screening measures and chemoprophylaxis guidelines concerning GBS infections must be established for pregnant women in Iran and these guidelines must provide guidance for obstetricians, midwives and neonatologists on the prevention of GBS infections
Variation in Reported Neonatal Group B Streptococcal Disease Incidence in Developing Countries
Clinical Infectious Diseases, 2012
Group B Streptococcus (GBS) is a leading cause of neonatal sepsis in developed countries. Its burden in the developing world is less clear. Studies reporting neonatal GBS disease incidence from developing countries were identified from 5 literature databases. Studies were assessed with respect to case finding and culture methods. Only 20 studies were identified. The GBS incidence ranged 0-3.06 per 1000 live births with variation within and between geographic regions. All but 1 study identified GBS cases within a hospital setting, despite the potential for births in the community. Possible case under-ascertainment was only discussed in 2 studies. A higher GBS incidence was reported when using automated culture methods. Prospective, population-based surveillance is urgently needed in developing countries to provide an accurate assessment of the neonatal GBS disease burden. This will be crucial for the design of interventions, including novel vaccines, and the understanding of their potential to impact mortality from neonatal sepsis.
Clinical Infectious Diseases, 2017
Background. We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. Methods. For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. Results. Worldwide in 2015, we estimated 205 000 (uncertainty range [UR], 101 000-327 000) infants with early-onset disease and 114 000 (UR, 44 000-326 000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19 000) presented with neonatal encephalopathy. There were 90 000 (UR, 36 000-169 000) deaths in infants <3 months age, and, at least 10 000 (UR, 3 000-27 000) children with disability each year. There were 33 000 (UR, 13 000-52 000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12 000-104 000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107 000 (UR, 20 000-198 000) stillbirths and infant deaths. Conclusions. Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409 000 (UR, 144 000-573 000) maternal/fetal/infant cases and 147 000 (UR, 47 000-273 000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.
F1000 - Post-publication peer review of the biomedical literature
Background. We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. Methods. For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. Results. Worldwide in 2015, we estimated 205 000 (uncertainty range [UR], 101 000-327 000) infants with early-onset disease and 114 000 (UR, 44 000-326 000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19 000) presented with neonatal encephalopathy. There were 90 000 (UR, 36 000-169 000) deaths in infants <3 months age, and, at least 10 000 (UR, 3 000-27 000) children with disability each year. There were 33 000 (UR, 13 000-52 000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12 000-104 000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107 000 (UR, 20 000-198 000) stillbirths and infant deaths. Conclusions. Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409 000 (UR, 144 000-573 000) maternal/fetal/infant cases and 147 000 (UR, 47 000-273 000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.
Pediatric Infectious Disease Journal, 2016
Background: Group B Streptococcus (GBS) is a predominant cause of early-onset neonatal sepsis globally; however, the impact of this organism on the health of newborns in South Asia is debated, due in part to a paucity of community-based assessments. We estimated the prevalence and serotypes of GBS colonization of the umbilical cord stump and the association of colonization with mortality in a population-based cohort of newborns in rural Sylhet District, Bangladesh. Methods: Umbilical cord swabs were collected from 646 newborns up to 3 times within the first week after birth (ages <24 hours, ~3 days, ~6 days) and processed to identify GBS serotypes. Results: GBS was isolated from 6.3% (41/646) of newborns. Sixty-one percent of the GBS colonization occurred in neonates within 24 hours of delivery. Serotypes VII (37.1%, n = 13/36) and Ia (33.3%, n = 12/36) were the most predominant colonizing GBS isolates. Other detected serotypes were Ib (11.1%, n = 4/36), II (11.1%, n = 4/36), V (5.6%, n = 2/36) and VI (2.8%, n = 1/36). Mortality risk among newborns with GBS colonization was 6.6 (95% confidence interval: 2.1-20.4) times higher than for those without GBS. Conclusions: The overall prevalence of GBS colonization was lower than in settings, where GBS is a predominant etiology of neonatal illness. In addition, the GBS serotype distribution differed from that reported in the developed part of the world. However, further studies are needed to understand the true burden of GBS-related illness. Mortality risk was substantially increased in the presence of GBS on the umbilical stump, providing support for chlorhexidine antisepsis to the cord to prevent colonization of invasive pathogens.
BMC Pediatrics, 2015
Background: Group B Streptococcus (GBS) is a leading cause of serious infection in very young infants. Robust incidence data from many geographic regions, including Latin America and Asia, are however lacking. Methods: A multicenter, hospital-based observational study was performed in Panama, Dominican Republic, Hong Kong and Bangladesh. All represented urban, tertiary referral hospitals, except Bangladesh. GBS cases (microbiological isolation from normally sterile sites in infants aged 0-89 days) were collected over 12 months. Results: At 2.35 (95 % CI: 1.74-3.18) cases per 1000 live births, the incidence of early onset GBS disease (EOD) was highest in the Dominican Republic, compared with 0.76 (95 % CI: 0.41-1.39) in Hong Kong and 0.77 (95 % CI: 0.44-1.35) in Panama, while no cases were identified in Bangladesh. Over 90 % of EOD cases occurred on the first day of life, with case fatality ratios ranging from 6.7 % to 40 %, varying by center, age of onset and clinical presentation. Overall, 90 % of GBS (EOD and late onset disease) was due to serotypes Ia, Ib and III. Conclusions: The incidence rate of early onset GBS infection reported in Dominican Republic was not dissimilar from that described in the United States prior to screening and intrapartum antibiotic prophylaxis, while the incidence in Hong Kong was higher than previously reported in the Asian region. The failure to identify GBS cases in Bangladesh highlights a need to better understand the contribution of population, healthcare and surveillance practice to variation in reported incidence. Overall, the identified disease burden and serotype distribution support the need for effective prevention methods in these populations, and the need for community based surveillance studies in rural areas where access to healthcare may be challenging.
Journal of clinical microbiology, 2017
Group B Streptococcus (GBS) infection is a leading cause of death in newborns in developed countries. Data on burden of GBS in Asian countries is lacking. This study aimed to understand i) rate of maternal recto-vaginal GBS carriage, ii) vertical transmission of GBS as determined by culturing ear, umbilicus and nasal swabs, and iii) distribution of GBS serotypes. This prospective observational study was conducted from September 2012 to November 2013 at Kumudini Hospital, a secondary level hospital, at Mirzapur, Bangladesh. The study enrolled pregnant women who visited the out-patient clinic for antenatal care (ANC) and/or delivered a child at the in-patient department of Kumudini Hospital, and babies born to these mothers. Among 1151 enrolled pregnant women, 172 (15%; 95% CI: 13%-17%) carried GBS and 26 (38%; 95% CI: 27%-51%) babies born to the mothers (n=68) with carriage had GBS on their body surface, indicating vertical transmission. Typing of the isolates (n=172) identified all ...
2008
In industrialised countries, Group B streptococci (Streptococcus agalactiae, GBS) have been a leading cause of morbidity and mortality among newborns for more than 30 years. Resulting in pneumonia, sepsis and meningitis, GBS affects 0.5 to three of every 1,000 live births in different populations. 1-6 Over 80% of cases occur in the first six days after birth-early-onset disease (EOD)-and of these most occur within 12-24 hours of birth. 3,7 EOD is typically related to maternal carriage of GBS in the genital tract, with vertical transmission occurring prior to or during labour and delivery. A second peak of disease incidence occurs around one month after birth-late-onset disease (LOD)-and accounts for the remaining 20% of cases. 2 In LOD, GBS is acquired perinatally ,
Epidemiology of Group B Streptococcus in developing countries
Vaccine, 2013
Group B Streptococcus (GBS) causes pneumonia, meningitis and sepsis in neonates. The current distribution pattern of GBS serotypes in developing countries such as India, China and Brazil is not clear. In order to appropriately plan for vaccination programs to address the burden of this disease in these countries, prospective population based studies are urgently needed. In our discussions, we focused on India, China and Brazil because of the membership of our workgroup, but data on other countries are also presented here. Further studies in developing countries are needed so as to better formulate appropriate public health interventions.