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Clin Infect Dis. 2017 Nov 6;65(suppl_2):S100-S111. doi: 10.1093/cid/cix658.

Maternal Colonization With Group B Streptococcus and Serotype Distribution 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
Centre for International Child Health, Imperial College London, United Kingdom.
5
Paediatric Infectious Diseases Research Group, St George's, University of London, United Kingdom.
6
Hospital Clínica Corpas, Bogotá, Colombia.
7
Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
8
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
9
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa.
10
Global Alliance to Prevent Prematurity and Stillbirth.
11
Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
12
Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
13
National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
14
Department of Global Health, University of Washington, Seattle.
15
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
16
Bill & Melinda Gates Foundation, Seattle, Washington.
17
World Health Organization, Geneva, Switzerland.
18
Bangladesh Institute of Child Health, Dhaka.
19
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong.

Abstract

Background:

Maternal rectovaginal colonization with group B Streptococcus (GBS) is the most common pathway for GBS disease in mother, fetus, and newborn. This article, the second in a series estimating the burden of GBS, aims to determine the prevalence and serotype distribution of GBS colonizing pregnant women worldwide.

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), organized Chinese language searches, and sought unpublished data from investigator groups. We applied broad inclusion criteria to maximize data inputs, particularly from low- and middle-income contexts, and then applied new meta-analyses to adjust for studies with less-sensitive sampling and laboratory techniques. We undertook meta-analyses to derive pooled estimates of maternal GBS colonization prevalence at national and regional levels.

Results:

The dataset regarding colonization included 390 articles, 85 countries, and a total of 299924 pregnant women. Our adjusted estimate for maternal GBS colonization worldwide was 18% (95% confidence interval [CI], 17%-19%), with regional variation (11%-35%), and lower prevalence in Southern Asia (12.5% [95% CI, 10%-15%]) and Eastern Asia (11% [95% CI, 10%-12%]). Bacterial serotypes I-V account for 98% of identified colonizing GBS isolates worldwide. Serotype III, associated with invasive disease, accounts for 25% (95% CI, 23%-28%), but is less frequent in some South American and Asian countries. Serotypes VI-IX are more common in Asia.

Conclusions:

GBS colonizes pregnant women worldwide, but prevalence and serotype distribution vary, even after adjusting for laboratory methods. Lower GBS maternal colonization prevalence, with less serotype III, may help to explain lower GBS disease incidence in regions such as Asia. High prevalence worldwide, and more serotype data, are relevant to prevention efforts.

KEYWORDS:

colonization; group B Streptococcus; pregnancy; serotypes; vaginal

PMID:
29117327
PMCID:
PMC5848259
DOI:
10.1093/cid/cix658
[Indexed for MEDLINE]
Free PMC Article

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