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

Lola Madrid,Clare Cutland,Johan Vekemans,Maya Kohli-Lynch,Joy E Lawn,Kirsty Le Doare,Paul T Heath,Linda Bartlett,Margaret Ip,Carol J Baker ,Samir K Saha ,Karen Edmond ,Michael G Gravett ,Ajoke Sobanjo Ter Meulen ,Anna C Seale ,Craig E Rubens ,Shabir A Madhi ,Stephanie J Schrag

doi:10.1093/cid/cix656

Abstract

BackgroundGroup 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.MethodsWe 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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0–89 days.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.ResultsWe 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.ConclusionsThe 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.

Highlights

Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP)
The incidence of infant GBS disease remains high in some regions, Africa
The general methods are described elsewhere [12]; here we present details specific to estimates related to the incidence of invasive GBS disease among infants

Summary

Objectives

1. To provide a comprehensive, systematic literature review and meta-analyses on the burden of infant invasive GBS disease to include: a. Incidence of infant GBS disease: overall incidence risk, including stratification by EOGBS and LOGBS. B. CFR for EOGBS and LOGBS (7–89 days) and neonatal disease (7–27 days). C. Serotype distribution: prevalence of GBS serotypes causing GBS disease among infants. 2. To generate parameters to be used as data inputs in a compartmental model estimating the burden of GBS in pregnancy for women, stillbirth, and infants; including a. B. Clinical syndrome (proportion of neonatal disease that was meningitis or sepsis)

Methods

Results

Discussion

Conclusion