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Clin Infect Dis. 2017 Nov 6;65(suppl_2):S200-S219. doi: 10.1093/cid/cix664.

Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children.

Author information

1
Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.
2
College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
3
King's College London, United Kingdom.
4
Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom.
5
Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom.
6
Department of Reproductive Health Research, University College London Institute for Women's Health, United Kingdom.
7
ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Spain.
8
Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
9
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
10
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.
11
Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.
12
Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle.
13
Vaccine Institute, Institute for Infection and Immunity, St George's University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom.
14
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong.
15
Centre for International Child Health, Imperial College London, United Kingdom.
16
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.
17
National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
18
Department of Global Health, University of Washington, Seattle.
19
Bangladesh Institute of Child Health, Dhaka.
20
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
21
Bill & Melinda Gates Foundation, Seattle, Washington.
22
World Health Organization, Geneva, Switzerland.

Abstract

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 205000 (uncertainty range [UR], 101000-327000) infants with early-onset disease and 114000 (UR, 44000-326000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19000) presented with neonatal encephalopathy. There were 90000 (UR, 36000-169000) deaths in infants <3 months age, and, at least 10000 (UR, 3000-27000) children with disability each year. There were 33000 (UR, 13000-52000) cases of invasive GBS disease in pregnant or postpartum women, and 57000 (UR, 12000-104000) 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 107000 (UR, 20000-198000) stillbirths and infant deaths.

Conclusions:

Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409000 (UR, 144000-573000) maternal/fetal/infant cases and 147000 (UR, 47000-273000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.

KEYWORDS:

group B Streptococcus; infection; maternal; newborn; stillbirth

PMID:
29117332
PMCID:
PMC5849940
DOI:
10.1093/cid/cix664
[Indexed for MEDLINE]
Free PMC Article

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