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Clin Infect Dis. 2017 Nov 6;65(suppl_2):S160-S172. doi: 10.1093/cid/cix656.

Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses.

Author information

1
ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic-University of Barcelona, Spain.
2
Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.
3
Centro de Investigação em Saúde de Manhiça, Mozambique.
4
College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
5
Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
6
United Nations Children's Fund, Afghanistan.
7
Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom.
8
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.
9
National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
10
Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
11
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
12
Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.
13
Department of Obstetrics and Gynecology, University of Washington, Seattle.
14
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong.
15
Centre for International Child Health, Imperial College London, United Kingdom.
16
Department of Global Health, University of Washington, Seattle.
17
Bangladesh Institute of Child Health, Dhaka.
18
Bill & Melinda Gates Foundation, Seattle, Washington.
19
World Health Organization, Geneva, Switzerland.
20
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Abstract

Background:

Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates.

Methods:

We conducted systematic literature 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 regarding invasive GBS disease in infants aged 0-89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence.

Results:

We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI], .43-.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI, .36-.47); late-onset disease incidence was 0.26 (95% CI, .21-.30). CFR was 8.4% (95% CI, 6.6%-10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V.

Conclusions:

The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.

KEYWORDS:

case fatality risk; early onset; estimate; group B Streptococcus; late onset

PMID:
29117326
PMCID:
PMC5850457
DOI:
10.1093/cid/cix656
[Indexed for MEDLINE]
Free PMC Article

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