Epidemiology and management of group B streptococcal colonization during pregnancy in Africa

Abstract

Group B streptococcal infections are a leading cause of neonatal morbidity and mortality. Maternal microbiological screening during pregnancy and intrapartum antimicrobial treatment of maternal group B streptococcus (GBS) colonization constitutes an effective prevention strategy to reduce early neonatal invasive disease due to GBS in the European and North American setting. Data on the prevalence of GBS colonization in pregnancy and incidence of neonatal invasive GBS disease are very limited for low-income regions. However, the first reports from sub-Saharan Africa indicate that GBS colonization rates may be comparable to industrialized countries and that related neonatal morbidity and mortality is of significance. Prior to the development of suitable prevention strategies, which are undoubtedly needed in resource poor settings, more evidence on GBS epidemiology in sub-Saharan Africa and assessment of cost effectiveness of different prevention strategies are essential.

Prevalence of colonization by Streptococcus agalactiae among pregnant women in Bukavu, Democratic Republic of the Congo

“…In Morocco, one study found asymptomatic carriage rate of 23.3% [3]. Similar or higher rates were found in Southern Africa [10,[12][13][14]. Our study, which is the first on this topic to be conducted in the DRC, had similar results.…”

“…As stated earlier, the relatively high rate of vaginal colonization with GBS and its pathogenicity have justified the implementation of screening, prevention, and treatment strategies [2,4,7,12]. Clinical practice guidelines have advocated intrapartum antibiotherapy to prevent GBS infection of the neonate, but the expected prevention of late-onset neonatal infection does not seem to be supported by conclusive data [4].…”

“…Given these differences, standardized screening methods have been proposed because part of the reported variations may reflect differences in methodology rather than possible real differences in prevalence. However, in general, prevalence rates on the African continent seem to be similar to those of developed countries [12]. In Morocco, one study found asymptomatic carriage rate of 23.3% [3].…”

Group B streptococcal carriage, antimicrobial susceptibility, and virulence related genes among pregnant women in Alexandria, Egypt

“…1,4 In low-income settings screening and IAP for prevention of invasive neonatal disease are mostly not implemented due to limitations in resources and infrastructure. 5 GBS remain fully susceptible to penicillin as well as to most blactams. [6][7][8][9] However, there are some worrisome reports on reduced penicillin susceptibility in GBS.…”

Streptococcus agalactiae Serotype Distribution and Antimicrobial Susceptibility in Pregnant Women in Gabon, Central Africa

“…In industrialized countries prenatal screening in pregnant women and intra-partum antibiotic prophylaxis (IAP) have been widely established and successfully reduced the incidence of newborn morbidity and mortality related to S. agalactiae 1 2 . In low income settings recto-vaginal colonization rates with S. agalactiae in pregnant women are similar 3 ; however, screening and IAP for prevention of invasive neonatal disease is mostly not implemented due to limitations in resources and infrastructure. Vaccination of pregnant women is an alternative prevention strategy that proved effective for other neonatal infectious diseases (i.e.…”