Maternal Disease With Group B  Streptococcus  and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

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Abstract

From the limited data available, the incidence of maternal group B streptococcal (GBS) disease in developed countries appears lower than, but comparable to, the incidence of early-onset neonatal GBS disease. There are no published data from low- and middle-income contexts.

Abstract

Background

Infections such as group B Streptococcus (GBS) are an important cause of maternal sepsis, yet limited data on epidemiology exist. This article, the third of 11, estimates the incidence of maternal GBS disease 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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on invasive GBS disease in women pregnant or within 42 days postpartum. We undertook meta-analyses to derive pooled estimates of the incidence of maternal GBS disease. We examined maternal and perinatal outcomes and GBS serotypes.

Results

Fifteen studies and 1 unpublished dataset were identified, all from United Nations–defined developed regions. From a single study with pregnancies as the denominator, the incidence of maternal GBS disease was 0.38 (95% confidence interval [CI], .28–.48) per 1000 pregnancies. From 3 studies reporting cases by the number of maternities (pregnancies resulting in live/still birth), the incidence was 0.23 (95% CI, .09–.37). Five studies reported serotypes, with Ia being the most common (31%). Most maternal GBS disease was detected at or after delivery.

Conclusions

Incidence data on maternal GBS disease in developing regions are lacking. In developed regions the incidence is low, as are the sequelae for the mother, but the risk to the fetus and newborn is substantial. The timing of GBS disease suggests that a maternal vaccine given in the late second or early third trimester of pregnancy would prevent most maternal cases.

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Most cited references 38

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Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement

Gretchen Stevens, Leontine Alkema, Robert E Black … (2016)

Gretchen Stevens and colleagues present the GATHER statement, which seeks to promote good practice in the reporting of global health estimates.

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Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005.

Anne Schuchat, J Phares, E. Zell … (2008)

Group B streptococcus is a leading infectious cause of morbidity in newborns and causes substantial disease in elderly individuals. Guidelines for prevention of perinatal disease through intrapartum chemoprophylaxis were revised in 2002. Candidate vaccines are under development. To describe disease trends among populations that might benefit from vaccination and among newborns during a period of evolving prevention strategies. Analysis of active, population-based surveillance in 10 states participating in the Active Bacterial Core surveillance/Emerging Infections Program Network. Age- and race-specific incidence of invasive group B streptococcal disease. There were 14,573 cases of invasive group B streptococcal disease during 1999-2005, including 1348 deaths. The incidence of invasive group B streptococcal disease among infants from birth through 6 days decreased from 0.47 per 1000 live births in 1999-2001 to 0.34 per 1000 live births in 2003-2005 (P < .001), a relative reduction of 27% (95% confidence interval [CI], 16%-37%). Incidence remained stable among infants aged 7 through 89 days (mean, 0.34 per 1000 live births) and pregnant women (mean, 0.12 per 1000 live births). Among persons aged 15 through 64 years, disease incidence increased from 3.4 per 100,000 population in 1999 to 5.0 per 100,000 in 2005 (chi2(1) for trend, 57; P < .001), a relative increase of 48% (95% CI, 32%-65%). Among adults 65 years or older, incidence increased from 21.5 per 100,000 to 26.0 per 100,000 (chi2(1) for trend, 15; P < .001), a relative increase of 20% (95% CI, 8%-35%). All 4882 isolates tested were susceptible to penicillin, ampicillin, and vancomycin, but 32% and 15% were resistant to erythromycin and clindamycin, respectively. Serotypes Ia, Ib, II, III, and V accounted for 96% of neonatal cases and 88% of adult cases. Among infants from birth through 6 days, the incidence of group B streptococcal disease was lower in 2003-2005 relative to 1999-2001. This reduction coincided with the release of revised disease prevention guidelines in 2002. However, the disease burden in adults is substantial and increased significantly during the study period.

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Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism [ISRCTN74215569]

Gary T Kinasewitz, S. Yan, Bruce Basson … (2004)

Introduction PROWESS (Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis) was a phase III, randomized, double blind, placebo controlled, multicenter trial conducted in patients with severe sepsis from 164 medical centers. Here we report data collected at study entry for 1690 patients and over the following 7 days for the 840 patients who received placebo (in addition to usual standard of care). Methods Nineteen biomarkers of coagulation activation, anticoagulation, fibrinolysis, endothelial injury, and inflammation were analyzed to determine the relationships between baseline values and their change over time, with 28-day survival, and type of infecting causative micro-organism. Results Levels of 13 of the 19 biomarkers at baseline correlated with Acute Physiology and Chronic Health Evaluation II scores, and nearly all patients exhibited coagulopathy, endothelial injury, and inflammation at baseline. At study entry, elevated D-dimer, thrombin–antithrombin complexes, IL-6, and prolonged prothrombin time were present in 99.7%, 95.5%, 98.5%, and 93.4% of patients, respectively. Markers of endothelial injury (soluble thrombomodulin) and deficient protein C, protein S, and antithrombin were apparent in 72%, 87.6%, 77.8%, and 81.7%, respectively. Impaired fibrinolysis (elevated plasminogen activator inhibitor-1) was observed in 44% of patients. During the first 7 days, increased prothrombin time (which is readily measurable in most clinical settings) was highly evident among patients who were not alive at 28 days. Conclusion Abnormalities in biomarkers of inflammation and coagulation were related to disease severity and mortality outcome in patients with severe sepsis. Coagulopathy and inflammation were universal host responses to infection in patients with severe sepsis, which were similar across causative micro-organism groups.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Infect Dis

Journal ID (iso-abbrev): Clin. Infect. Dis

Journal ID (publisher-id): cid

Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

Publisher: Oxford University Press (US )

ISSN (Print): 1058-4838

ISSN (Electronic): 1537-6591

Publication date (Print): 15 November 2017

Publication date (Electronic): 06 November 2017

Publication date PMC-release: 06 November 2017

Volume: 65

Issue: Suppl 2 , The Burden of Group B Streptococcus Worldwide for Pregnant Women, Stillbirths, and Children

Pages: S112-S124

Affiliations

[1 ] Department of Reproductive Health Research, University College London Institute for Women’s Health , United Kingdom;

[2 ] School of Social and Community Medicine, University of Bristol, United Kingdom ;

[3 ] Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland;

[4 ] Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine , United Kingdom;

[5 ] College of Health and Medical Sciences, Haramaya University , Dire Dawa, Ethiopia;

[6 ] Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England , London,United Kingdom;

[7 ] Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine , Houston, Texas;

[8 ] 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;

[9 ] Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust , United Kingdom;

[10 ] Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong ;

[11 ] Centre for International Child Health, Imperial College London , United Kingdom;

[12 ] National Institute for Communicable Diseases, National Health Laboratory Service , Johannesburg, South Africa;

[13 ] Global Alliance to Prevent Prematurity and Stillbirth , Seattle, Washington;

[14 ] Department of Global Health, University of Washington , Seattle;

[15 ] Bangladesh Institute of Child Health , Dhaka;

[16 ] National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia;

[17 ] Bill & Melinda Gates Foundation , Seattle, Washington;

[18 ] World Health Organization , Geneva, Switzerland; and

[19 ] Department of Obstetrics and Gynecology, University of Washington , Seattle

Author notes

Correspondence: J. Hall, University College London Institute for Women’s Health, UCL EGA IfWH, Medical School Building, 74 Huntley Street, London WC1E 6AU ( jennifer.hall@ 123456ucl.ac.uk ).

Article

Publisher ID: cix660

DOI: 10.1093/cid/cix660

PMC ID: 5850000

PubMed ID: 29117328

SO-VID: a01adaee-7ca3-4288-8d94-6cb74a2a043e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

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Pages: 13

Funding

Funded by: National Institutes of Health 10.13039/100000002

Funded by: Wellcome Trust 10.13039/100004440

Funded by: London School of Hygiene and Tropical Medicine 10.13039/100009660

Funded by: Bill and Melinda Gates Foundation 10.13039/100000865

Award ID: OPP1131158

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Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 38

Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement

Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005.

Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism [ISRCTN74215569]

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Cited by 51

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