Invasive Group B Streptococcal Infection in Infants, Malawi

Katherine J Gray,Neil French,Amos J Phiri,Sally L Bennett,Stephen M Graham

doi:10.3201/eid1302.060680

Abstract

Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi. In Queen Elizabeth Central Hospital, Blantyre, Malawi, during May 2004-June 2005, GBS were isolated from routine blood and cerebrospinal fluid cultures from 57 infants. The incidence of early (EOD) and late onset (LOD) invasive GBS disease was 0.92 and 0.89 cases per 1,000 live births, respectively. Sepsis (52%) was the most common manifestation of EOD; meningitis (43%) and sepsis (36%) were the principal manifestations of LOD. The case-fatality rate was 33% overall (38% EOD, 29% LOD). Serotypes Ia and III were responsible for 77% of disease. All isolates were susceptible to penicillin, but 21% were resistant to erythromycin. The rate and manifestations of neonatal GBS disease in Malawi are similar to those in industrialized countries, but the case-fatality rate is higher than in industrialized countries. Effective locally relevant prevention strategies are needed.

Highlights

Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi
*Malawi-Liverpool–Wellcome Trust Programme of Clinical Tropical Research, Blantyre, Malawi; and †College of Medicine, Blantyre, Malawi cause of neonatal sepsis in Africa. The largest of these studies reported that 136 of 801 bacterial isolates from 784 Malawian neonates were GBS, which makes it the most common cause of sepsis among neonates admitted to Queen Elizabeth Central Hospital (QECH) in Blantyre [16]. Prevention strategies such as chemoprophylaxis are available for neonatal GBS but are difficult to apply in a resource-limited setting [4,5]
Vaccination is an attractive option in this setting, and vaccines consisting of GBS capsular polysaccharide conjugated to a tetanus toxoid carrier protein have been under development [17,18,19,20]

Summary

Introduction

Group B streptococci (GBS) are a recently identified cause of neonatal sepsis in Malawi. Recent studies from Kenya [10,11,12], South Africa [13,14], Zimbabwe [15], and Malawi [16] suggest that GBS is emerging as an important. Prevention strategies such as chemoprophylaxis are available for neonatal GBS but are difficult to apply in a resource-limited setting [4,5]. Important information to support future preventive strategies includes estimate of rates of disease, timing of disease initial manifestations; and for vaccine development, description of serotype distribution in different populations [5]. We set out to further characterize GBS disease in Blantyre District in Malawi

Methods

Results

Conclusion