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Clin Infect Dis. 2017 Nov 6;65(suppl_2):S152-S159. doi: 10.1093/cid/cix655.

Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analyses.

Author information

1
Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.
2
King's College London, United Kingdom.
3
College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
4
Paediatric Infectious Diseases Research Group, St George's, University of London, United Kingdom.
5
Centre for International Child Health, Imperial College London, United Kingdom.
6
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
7
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
8
Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.
9
Department of Obstetrics and Gynecology, University of Washington, Seattle.
10
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong.
11
National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
12
Department of Global Health, University of Washington, Seattle.
13
Bangladesh Institute of Child Health, Dhaka.
14
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
15
Bill & Melinda Gates Foundation, Seattle, Washington.
16
World Health Organization, Geneva, Switzerland.
17
Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.

Abstract

Background:

Early-onset group B streptococcal disease (EOGBS) occurs in neonates (days 0-6) born to pregnant women who are rectovaginally colonized with group B Streptococcus (GBS), but the risk of EOGBS from vertical transmission has not been systematically reviewed. This article, the seventh in a series on the burden of GBS disease, aims to estimate this risk and how it varies with coverage of intrapartum antibiotic prophylaxis (IAP), used to reduce the incidence of EOGBS.

Methods:

We conducted systematic reviews (Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on maternal GBS colonization and neonatal outcomes. We included articles with ≥200 GBS colonized pregnant women that reported IAP coverage. We did meta-analyses to determine pooled estimates of risk of EOGBS, and examined the association in risk of EOGBS with IAP coverage.

Results:

We identified 30 articles including 20328 GBS-colonized pregnant women for inclusion. The risk of EOGBS in settings without an IAP policy was 1.1% (95% confidence interval [CI], .6%-1.5%). As IAP increased, the risk of EOGBS decreased, with a linear association. Based on linear regression, the risk of EOGBS in settings with 80% IAP coverage was predicted to be 0.3% (95% CI, 0-.9).

Conclusions:

The risk of EOGBS among GBS-colonized pregnant women, from this first systematic review, is consistent with previous estimates from single studies (1%-2%). Increasing IAP coverage was linearly associated with decreased risk of EOGBS disease.

KEYWORDS:

Streptococcus agalactiae; group B Streptococcus; neonatal sepsis; risk; vertical transmission

PMID:
29117325
PMCID:
PMC5850448
DOI:
10.1093/cid/cix655
[Indexed for MEDLINE]
Free PMC Article

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