Group B Streptococcus Prevention Research Articles

Maternity care provider acceptance of a future Group B Streptococcus vaccine - A qualitative study in three countries.

There are vaccines in clinical trials that target the bacterium Group B Streptococcus (GBS). When approved, GBS vaccines will be intended for administration to pregnant women to prevent infection in their infants. The success of any vaccine will depend on its' uptake in the population. Experience with prior maternal vaccines, e.g. influenza, Tdap and COVID-19 vaccines, teaches us that acceptance of vaccines, especially if novel, is challenging for pregnant women, and that provider recommendation is a key driver of vaccine uptake. This study investigated attitudes of maternity care providers towards the introduction of a GBS vaccine in three countries (the United States (US), Ireland, and the Dominican Republic (DR)) with different GBS prevalence and prevention practices. Semi-structured interviews with maternity care providers were transcribed and coded for themes. The constant comparative method, and inductive theory building were used to develop conclusions. Thirty-eight obstetricians, 18 general practitioners and 14 midwives participated. There was variability in provider attitudes towards a hypothetical GBS vaccine. Responses ranged from enthusiasm to doubts over the need for a vaccine. Attitudes were influenced by perceived additional benefits of a vaccine over current strategy and confidence in the safety of vaccines during pregnancy. Knowledge, experience and approaches to GBS prevention differed geographically and according to provider type, and influenced how participants assessed the risks and benefits of a GBS vaccine. Maternity care providers are engaged in the topic of GBS management and there is opportunity to leverage attitudes and beliefs that will support a strong recommendation for a GBS vaccine. However, knowledge of GBS, and of the limitations of current prevention strategies vary among providers in different regions, and between different provider types. Targeted educational efforts with antenatal providers should focus on highlighting safety data the potential benefits of vaccination over current strategies.

Maternal Group B Streptococcal Rectovaginal Colonization after Intrapartum Antibiotic Prophylaxis.

Maternal rectovaginal colonization with Group B Streptococcus (GBS) during labor is a prerequisite for neonatal early-onset GBS disease. Intrapartum antibiotic prophylaxis (IAP) has been proven to prevent GBS perinatal infection, while there are few studies on the evaluation of the effectiveness of different antibiotic prophylaxis regimens. This study aimed to assess the maternal rectovaginal GBS colonization status after IAP, antimicrobial susceptibility and maternal and neonatal outcomes among women administered different antibiotic prophylaxis regimens. A prospective study was conducted between June 2018 and June 2022. GBS carriers identified at 35-37 weeks of gestation were provided IAP (penicillin, cefazolin or clindamycin) at delivery based on the local protocol for GBS prevention. Rectovaginal samples were obtained from participants again after delivery. Antimicrobial susceptibility testing in GBS isolates was performed using the broth microdilution method. A total of 295 cases were included in this study. In the postpartum re-examination for GBS, the overall negative rectovaginal culture rate was 90.8% (268/295). Women who received cefazolin prophylaxis had the highest negative culture rate (95.2%, 197/207), which was followed by those who received penicillin (80.7%, 67/83) and clindamycin (80.0%, 4/5) (p = 0.001). All GBS isolates achieved sensitivity to penicillin and cefazolin, whereas resistance to clindamycin was shown in 21.4% of the strains. There were no significant differences in maternal and neonatal outcomes among the IAP groups. The use of IAP is highly effective in reducing the maternal rectovaginal GBS colonization. Cefazolin may offer equivalent efficacy and safety compared to standard penicillin prophylaxis.

Genetic diversity and antimicrobial resistance of invasive, noninvasive and colonizing group B Streptococcus isolates in southern Brazil.

Introduction. Group B Streptococcus (GBS) is a human commensal bacterium that is also associated with infection in pregnant and non-pregnant adults, neonates and elderly people.Gap Statement. The authors hypothesize that knowledge of regional GBS genetic patterns may allow the use of prevention and treatment measures to reduce the burden of streptococcal disease.Aim. The aim was to report the genotypic diversity and antimicrobial sensitivity profiles of invasive, noninvasive urinary and colonizing GBS strains, and evaluate the relationships between these findings.Methodology. The study included consecutive and non-duplicated GBS isolates recovered in southern Brazil from 2015 to 2017. We performed multiple-locus variable-number tandem repeat analysis (MLVA) and PCR analyses to determine capsular serotypes and identify the presence of the resistance genes mefA/E, ermB and ermA/TR, and also antibiotic susceptibility testing.Results. The sample consisted of 348 GBS strains, 42 MLVA types were identified, and 4 of them represented 64 % of isolates. Serotype Ia was the most prevalent (42.2 %) and was found in a higher percentage associated with colonization, followed by serotypes V (24.4 %), II (17.8 %) and III (7.8 %). Serotype V was associated with invasive isolates and serotypes II and III with noninvasive isolates, without significant differences. All isolates were susceptible to penicillin. GBS 2018/ hvgA was observed in 17 isolates, with 11 belonging to serogroup III. The Hunter–Gaston diversity index was calculated as 0.879. The genes mefA/E, erm/B and erm/A/TR were found in 45, 19 and 46 isolates.Conclusion. This report suggests that the circulating GBS belong to a limited number of genetic lineages. The most common genotypes were Ia/MT12 and V/MT18, which are associated with high resistance to macrolides and the presence of the genes mefA/E and ermA/TR. Penicillin remains the antibiotic of choice. Implementation of continuous surveillance of GBS infections will be essential to assess GBS epidemiology and develop accurate GBS prevention, especially strategies associated with vaccination.

Preventing group B Streptococcus neonatal disease with intrapartum prophylaxis: a retrospective study to detect its use in case of unknown colonization status.

Group B Streptococcus (GBS) is the leading cause of neonatal morbidity and mortality in developed countries. This study aims primarily to estimate the prevalence of maternal GBS positivity and secondarily to evaluate the compliance and the effectiveness of the current GBS prevention protocol. This retrospective study has considered 27382 single pregnancies carried to delivery between 2001 and 2014 at our Obstetrics and Gynecology clinic. All women carrying a singleton pregnancy in the considered period were eligible to be included in this study. The GBS swab was positive in 17.66% of cases, negative in 51.93%, and unknown in 30.41%. Data collected revealed that out of the total of GBS-positive women, 3362 were treated with antibiotic prophylaxis, and 1331 were not. There were no differences between cases admitted to Neonatal Intensive Care Unit and perinatal deaths between treated and non-treated GBS-positive pregnancies. Moreover, the data showed that 74.62% of patients between 34 and 37 weeks of gestation at the time of delivery were treated with antibiotic prophylaxis unnecessarily, and 25.38% of patients >37 weeks of gestation whose GBS status at delivery was unknown would have required intrapartum antibiotic prophylaxis. The only risk factor for chorioamnionitis among GBS-positive women in multivariate logistic regression analysis was an early gestational age (OR 0.61; 95% CI: 0.56-0.66; P<0.05). GBS prevalence was found to be 17.66%, and prophylaxis in colonized patients was carried out correctly according to our internal procedure allowing a low incidence of adverse outcomes. Finally, the only risk factor associated with chorioamnionitis in GBS patients was early gestational age at delivery.

Virulence-genes Rib and Bca in Serotypes of Group B Streptococcus (GBS) Isolated from Symptomatic Pregnant Women in East Coast Malaysia

INTRODUCTION: Group B streptococcus (GBS) is a leading cause of maternally-acquired invasive infections in neonates. Nowadays maternal immunization is of utmost demand for prevention of these infections. We undertook capsular serotyping and virulence factor genes identification for local GBS isolates as a pilot study, to identify potential candidates to propagate vaccine development. MATERIALS AND METHODS: This is a descriptive lab -based study to determine GBS serotypes and presence of genes coding virulence factors bca and rib in isolates obtained from symptomatic pregnant women in Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia. Sixty-two GBS isolates from high vaginal swabs were collected. Latex agglutination test was performed to determine GBS serotypes. Real-time PCR was done to determine the presence of virulence genes. RESULTS: Of the 62 GBS isolates, 77.4% were serologically typeable, and 22.6% were non -typeable. Serotypes Ia and Ib (16.1% each) were the most common capsular types, followed by II, V, and VII (9.7% each), III (8.1%), VI (6.5%), and VIII (1.6 %). Furthermore, 67.7% of the isolates harboured the rib gene while 98.4% possessed the bca gene. CONCLUSION: The five known prevalent serotypes worldwide, do not match the CPS distribution in symptomatic pregnant women in Kuantan. However, the frequency of virulence genes rib and bca is high among our isolates, which if confirmed by further bigger and wider studies makes the proteinaceous vaccine, N-terminal domains of Rib and AlpC a suitable candidate for GBS prevention in this geographical area.

Prevalence, antimicrobial patterns, serotypes and risk factors for GBS rectovaginal isolates among pregnant women at Kenyatta Hospital

Background: Estimates of group B streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. Methods and materials: We evaluated the prevalence, antimicrobial susceptibility, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. In this cross-sectional study, consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization. Results: A total of 292 women were enrolled. Their median age was 30 years (Interquatile range {IQR} 26–35) with a median gestational age of 35 weeks (IQR 30–37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/60 (72.4%) isolates, ampicillin in 32/60 (55.2%) isolates, clindamycin in 14/60 (30.4%) isolates, and vancomycin in 14 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the tested risk factors was associated with GBS colonization. Conclusion: The prevalence of GBS colonization was high among mothers attending antenatal clinic at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.

Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China.

We performed a systematic review and meta-analysis of the incidence, case-fatality rate (CFR), isolate antimicrobial resistance patterns, and serotype and sequence type distributions for invasive group B Streptococcus (GBS) disease in infants <1–89 days of age in China. We searched the PubMed/Medline, Embase, Wanfang, and China National Knowledge Infrastructure databases for research published during January 1, 2000–March 16, 2018, and identified 64 studies. Quality of included studies was assessed by using Cochrane tools. Incidence and CFR were estimated by using random-effects meta-analyses. Overall incidence was 0.55 (95% CI 0.35–0.74) cases/1,000 live births, and the CFR was 5% (95% CI 3%–6%). Incidence of GBS in young infants in China was higher than the estimated global incidence (0.49 cases/1,000 live births) and higher than previous estimates for Asia (0.3 cases/1,000 live births). Our findings suggest that implementation of additional GBS prevention efforts in China, including maternal vaccination, could be beneficial.

Prevalence, antimicrobial susceptibility patterns, serotypes and risk factors for group B streptococcus rectovaginal isolates among pregnant women at Kenyatta National Hospital, Kenya; a cross-sectional study

BackgroundEstimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS.MethodsWe evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization.ResultsA total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26–35) and a median gestational age of 35 weeks (IQR 30–37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization.ConclusionThe prevalence of GBS colonization was high among antenatal women at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.

Significant shifts in the distribution of vaccine capsular polysaccharide types and rates of antimicrobial resistance of perinatal group B streptococci within the last decade in St. Petersburg, Russia.

Evaluation of circulating group B streptococcus (GBS) strains is important to assess the potential effects of GBS prevention strategies in a certain region. This study aimed at estimating the distributions of capsular polysaccharide (CPS) types and pilus profiles, and the rates of antimicrobial resistance among GBS strains isolated from colonized pregnant women and newborns in 2010-2011 and 2017-2018 in St. Petersburg, Russia. A total of 261 GBS isolates have been investigated. Antibiotic susceptibility testing was performed using the disc-diffusion method. CPS types and pilus profiles were determined by using PCR. Over the 9-year period, the resistance of GBS to both erythromycin and clindamycin has significantly increased, exceeding 30% in 2017-2018. The most prevalent CPS types were Ia, III, and V. Significant shifts were observed in the frequency of CPS types III (decreased) and V (increased), which resulted in a significant reduction (from 77 to 63%) in the potential coverage by a trivalent vaccine (including serotypes Ia, Ib, and III), whereas that of a pentavalent vaccine (including serotypes Ia, Ib, II, III, and V) remained largely unchanged (approximately 95%). The most common pilus profiles were PI-1/2a, PI-2a, and PI-1a/2b, and pilus genotype distribution has not changed with time. High and steadily growing resistance of perinatal GBS strains to clindamycin requires restricting its use to penicillin-allergic women at high risk for anaphylaxis and testing the GBS strains for their susceptibility to this antibiotic. A pentavalent CPS-based vaccine covers the vast majority of perinatal GBS strains in Russia.

Universal testing for group B streptococcus during pregnancy: need for a randomised trial.

A third of developed countries do not test for maternal group B streptococcus colonisation in pregnant women and follow a strategy of identifying maternal risk factors for EOGBS disease in the baby, and offering those 'higher risk groups' intrapartum antimicrobial prophylaxis. Hasperhoven et al (BJOG, 2020) present an updated systematic review of culture-based testing for group B streptococcus (GBS) colonisation in women or risk factor-based approach for prevention of newborn early-onset GBS (EOGBS) disease. The review identified 17 observational studies, of which 15 provided data for a meta-analysis and 11 directly compared screening protocols with risk-based strategies.

High Rate of Serotype V Streptococcus agalactiae Carriage in Pregnant Women in Botswana.

Maternal rectovaginal colonization is the major risk factor for early-onset neonatal sepsis due to Group B Streptococcus (GBS), a major cause of early life morbidity and mortality. Transmission generally occurs perinatally from colonized mothers to infants. Vaccines targeting a subset of GBS serotypes are under development, but GBS epidemiology remains poorly understood in many African nations. We performed a cross-sectional study of GBS colonization among pregnant women at two sites in Botswana, a country with minimal prior GBS carriage data. We found a rectovaginal colonization rate of 19%, comparable with studies in other regions; however, we also noted a striking predominance of serotype V (> 45% of strains). Although further studies are required to delineate the burden of invasive GBS disease in Botswana and the generalizability of type V epidemiology, these data provide a useful baseline for understanding the potential local impact of GBS prevention strategies, including vaccines.

Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015.

BackgroundMaternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001–2015, with a focus on GBS epidemiology and strain characteristics.MethodsCommunity-level birth and mortality data were obtained from Manhiça’s demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhiça district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing.ResultsThere were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (≥0.12 μg/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone.ConclusionA notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies.

Screening for group B Streptococcus (GBS) at labour onset using PCR: accuracy and potential impact – a pilot study

This pilot study assessed the diagnostic accuracy and potential impact of a rapid PCR-based screening test for the detection of group B Streptococcus (GBS) at the onset of labour for the purpose of optimising intrapartum antibiotic prophylaxis (IAP). Vaginal and rectal swabs from a convenience sample of 158 women were analysed by conventional broth-enriched culture and a rapid PCR test. Overall, GBS carriage was 18.98% by culture and 19.62% by PCR. PCR for the detection of GBS had a sensitivity of 93.1%, specificity of 96.67% and area under the curve (AUC) of 0.95. Only 19.3% GBS-positive women received IAP. Three-fourths of babies born to GBS-positive mothers did not receive surveillance for early-onset GBS disease. Of the women who received IAP, only 32.5% were GBS carriers. Seventy-four percent of the GBS-positive mothers delivered more than 5 h after recruitment, which gives adequate swab to delivery interval for appropriate antibiotic prophylaxis in labour.Impact statementWhat is already known about this subject: Appropriate intra-partum treatment of colonized mothers reduces the risk of GBS transmission to neonates. Universal ante partum screening of pregnant women or IAP based on risk factors in labour for GBS prevention fail to accurately identify and treat the woman who actually harbors GBS in the birth canal in labour. A PCR based rapid test, allows for real-time assessment of GBS carriage in labour.What this study adds: This study highlights the fact that a large number of GBS carriers in labour, who could potentially infect their babies, do not receive IAP, and most of their babies do not receive added surveillance in the neonatal period for EOGBS disease. It also confirms that PCR testing at onset of labour is a highly sensitive and reliable test that identifies the women who are GBS carriers in labour and hence need IAP.What the implications are of these findings for clinical practice and/or further research: Timely provision of IAP for the appropriate woman is possible by adopting universal GBS screening at the onset of labor using GBS-PCR. This would involve additional costs to health care facilities and added work to laboratory personnel.

Neonatal Group B Streptococcus Infections: Prevention Strategies, Clinical and Microbiologic Characteristics in 7 Years of Surveillance.

The characteristics of group B streptococcus (GBS) neonatal disease in a period of 7 years are reported. The estimation of the neonatal GBS disease risk and prevention strategies adopted at delivery in absence of national guidelines was evaluated by the analysis of 3501 questionnaires. Notification of 194 neonatal GBS infections was recorded. In addition, 115 strains from neonatal early-onset disease (EOD) and late-onset disease, respectively, plus 320 strains from pregnant women were analyzed by molecular typing methods and for antibiotic resistance. Preterm deliveries, precipitous labor and GBS negatively screened mothers were the prominent causes for an inadequate or lack of intrapartum antibiotic prophylaxis and EOD occurrence. The superimposable serotype distribution of GBS strains from EOD and from antenatal screening confirmed the vertical transmission from mother to neonate as the cause of disease. On the contrary, late-onset disease was almost exclusively caused by the internationally diffused clonal complex 17. Erythromycin resistance was detected in 17% of strains. Resistance to clindamycin was 15.3 %. The administration of intrapartum antibiotic prophylaxis to negatively GBS screened women in presence of risk factors was a deviation from the recommendations issued by the Centers for Disease Control and Prevention, and it should deserve further consideration. Routine surveillance and molecular typing of circulating clones are essential for the effective management of the neonatal GBS disease.

Early-Onset Neonatal Sepsis: A Continuing Problem in Need of Novel Prevention Strategies.

* Abbreviations: ABC — : Active Bacterial Core surveillance EOS — : early-onset neonatal sepsis GBS — : group B streptococcus IAP — : intrapartum antimicrobial prophylaxis Early-onset neonatal sepsis (EOS) remains a feared cause of severe illness and death among infants of all birthweights and gestational ages, with particular impact among preterm infants. Centers for Disease Control and Prevention investigators have studied the changing epidemiology of invasive EOS for several decades. The Active Bacterial Core surveillance (ABCs) network, a collaboration between the Centers for Disease Control and Prevention, state health departments, and universities, was established in 1995 to address emerging infectious diseases of public health importance, including infections due to major neonatal pathogens.1,2 ABCs data are remarkable because of the geographic distribution and size of the population-based network, laboratory-based identification of cases, linked epidemiologic and laboratory data, and surveillance over many years. In this issue of Pediatrics , Schrag and colleagues3 present ABCs data on the epidemiology of early-onset neonatal sepsis collected over a recent 10-year period, with special attention to group B streptococcal (GBS) and Escherichia coli infections. Invasive GBS infection among neonates, identified in the 1960s,4 emerged as the most common cause of EOS, with high risk of morbidity and mortality. National guidelines … Address correspondence to Barbara J. Stoll, MD, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB G.150, Houston, TX 77030. E-mail: barbara.j.stoll{at}uth.tmc.edu

Early-onset neonatal sepsis and the implementation of group B streptococcus prophylaxis in a Brazilian maternity hospital: a descriptive study

ObjectivesTo describe early-onset neonatal sepsis (EOS) epidemiology in a public maternity hospital in Brasilia, Brazil. MethodsWe defined EOS as a positive blood culture result obtained from infants aged ≤72 hours of life plus treatment with antibiotic therapy for ≥5 days. Incidence was calculated based on the number of cases and total live births (LB). This is a descriptive study comparing the period of 2012–2013 with the period of 2014–September 2015, before and after implementation of antibiotic prophylaxis during labor for group B streptococcus (GBS) prevention, respectively. ResultsOverall, 36 infants developed EOS among 21,219 LB (1.7 cases per 1000 LB) and 16 died (case fatality rate of 44%). From 2014, 305 vaginal-rectal swabs were collected from high-risk women and 74 (24%) turned out positive for GBS. After implementation of GBS prevention guidelines, no new cases of GBS were detected, and the EOS incidence was reduced from 1.9 (95% CI 1.3–2.8) to 1.3 (95% CI 0.7–2.3) cases per 1000 LB from 2012–2013 to 2014–September 2015 (p=0.32). ConclusionsAlthough the reduction of EOS incidence was not significant, GBS colonization among pregnant women was high, no cases of neonatal GBS have occurred after implementation of prevention guidelines.

Increasing postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis vaccine by incorporating pertussis cocooning information into prenatal education for group B streptococcus prevention

BackgroundTo evaluate whether incorporating pertussis cocooning information into prenatal education for group B streptococcus (GBS) prevention increased postpartum rate of vaccination with tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. MethodsWe performed a retrospective pre-intervention/post-intervention study of postpartum women at a teaching hospital in Taiwan. We compared the frequency of Tdap vaccination during the pre-intervention (May 1, 2009 to December 31, 2010) and post-intervention (March 1, 2011–March 31, 2012) time periods. The clinical intervention was incorporation of pertussis cocooning information into prenatal education for GBS prevention to pregnant women presented during a prenatal visit at 35–37 weeks of gestation. Postpartum Tdap vaccination rate during the pre-intervention and post-intervention periods was compared. We also specifically examined group differences in the percentage of women who received postpartum Tdap vaccination to explore factors that influenced their decision regarding Tdap vaccine. ResultsTdap vaccination was more likely during the post-intervention period compared with the pre-intervention period (2268 of 3186 [71.2%] compared with 2556 of 5030 [55.6%]; p<.001). Comparisons between each subgroup of pre-intervention and post-intervention women showed that incorporating pertussis information into prenatal education for GBS prevention was beneficial except for women of maternal age 30–34 years and women living in rural areas. ConclusionsPrenatal GBS screening activities represent an opportunity for healthcare providers to offer pertussis cocooning information to eligible pregnant women to improve rates of postpartum Tdap vaccination.

Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.

Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in NewZealand fiveyears after the publication of national risk-based GBS prevention guidelines. Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life. There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per1000 live births. Ten years after a similar survey and fiveyears after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.

The Acceptability of a Novel Group B Streptococcus Vaccine in Pregnant Women

INTRODUCTION: Group B streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality. Currently, intrapartum antibiotic treatment is the only means to decrease vertical transmission. Studies have shown that a vaccine administered during the third trimester is the most cost-effective option for GBS prevention, but the acceptability of such a vaccine to pregnant women is unknown. METHODS: Women 18 years of age or older and 20–40 weeks of gestation at the time of their obstetric visit to two university-affiliated clinics were eligible for participation. Participants read an informational handout on GBS and completed a survey rating, on an 11-point scale (0–10), the likelihood they would elect to receive vaccines with five variable characteristics. Statistical analyses were performed with SPSS 17. Conjoint analysis determined importance scores, which reflected the degree to which vaccine dimensions influenced scenario ratings (the sum of importance scores across the five dimensions 100). RESULTS: One hundred of 120 women approached completed the survey. The mean acceptability rating across all scenarios was 6.7 (standard deviation 2.3). Health care provider recommendation was the most influential (importance score 38.5) followed by vaccine efficacy (importance score 29.1). Vaccine cost (importance score 13.2), percentage of women vaccinated (importance score 11.8), and side effects (importance score 8.3) had less influence on ratings. CONCLUSIONS: When a GBS vaccine becomes available, health care provider endorsement, and therefore preemptive education will be critical in achieving high levels of vaccination in the pregnant population.

Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis

* Abbreviations: AAP — : American Academy of Pediatrics CBC — : complete blood cell COFN — : Committee on Fetus and Newborn COID — : Committee on Infectious Diseases GBS — : group B streptococcal MMWR — : Morbidity and Mortality Weekly Report In 2010, the Centers for Disease Control and Prevention in collaboration with the American Academy of Family Physicians, American Academy of Pediatrics (AAP), American College of Nurse-Midwives, American College of Obstetricians and Gynecologists, and American Society for Microbiology published revised group B streptococcal (GBS) guidelines entitled “Prevention of perinatal group B streptococcal disease: revised guidelines from CDC 2010” in the Morbidity and Mortality Weekly Report ( MMWR ).1 The recommendations were endorsed by all the collaborating organizations including AAP after review by the Committee on Infectious Diseases (COID) and the Committee on Fetus and Newborn (COFN) and after AAP Board approval. In the report, a revised algorithm for “Secondary prevention of early-onset group B streptococcal disease” was included. This algorithm represented the expert opinions of the technical working group (based on current literature available at that time). In 2011, the COID and the COFN published a policy statement in Pediatrics that was in agreement with the 2010 GBS guidelines and included the same algorithm.2 In the spring of 2012, the COFN published a clinical report containing management guidelines entitled “Management of neonates with suspected or proven early-onset neonatal sepsis.”3 The 2012 COFN document includes guidance on laboratory evaluations and treatment duration, which were not addressed in the 2010 GBS prevention guidelines. The algorithms at the end of the COFN report differed from those in the 2010 guidelines published in the MMWR .1 The discordance in the algorithms prompted questions by the pediatric community as to which recommendations … Address correspondence to Michael T. Brady, MD, 700 Children’s Dr, AB 7048, Columbus, OH 43205. E-mail: michael.brady{at}nationwidechildrens.org