Immunization Against Group B Streptococci vs. Intrapartum Antibiotic Prophylaxis in Peripartum Pregnant Women and their Neonates: A Review

Abstract

Group B streptococcus (GBS) is an organism that has an immense global impact on neonatal morbidity and mortality. GBS is known to colonize the gastrointestinal and genitourinary tracts of infected pregnant women. Transmission to the neonate is achieved during labor and delivery. Complications of neonatal infection include sepsis, meningitis, and pneumonia. Preventative measures are needed to reduce the disease burden. The current method of prophylaxis being utilized is intrapartum antibiotics. Though effective, it presents limitations that include a required, lengthy duration of treatment, increased antibiotic resistance, and lack of late-onset disease coverage. Recent studies are exploring alternative methods of prophylaxis such as vaccination. Vaccination provides coverage of both early and late-onset disease to infected women who are unable to complete the required four hours of antibiotic course intrapartum, women with resistance to antibiotic infections, and women delivering in resource-poor areas without access to antibiotics. An investigational CRM197 conjugated trivalent vaccine has shown a good immunogenicity profile against the three most prevalent serotypes. The vaccine induced antibodies freely cross the placenta and persist in a neonate for up to 90 days after birth. Additionally, the vaccine possesses a safety profile free of any serious systemic adverse effects and only mild pain at the injection site. Future studies should focus on investigating the effect of the vaccine on maternal rectovaginal acquisition and subsequent vaginal colonization, as well as the expansion of vaccine coverage to all 10 serotypes identified worldwide in order to facilitate its use in resource-poor areas of the world with inadequate antibiotic availability. If available, such a vaccine can serve as an effective supplement to current guidelines of antibiotic prophylaxis against GBS in peripartum women and their neonates.

Using Surface Immunogenic Protein as a Carrier Protein to Elicit Protective Antibody to Multiple Serotypes for Candidate Group B Streptococcal Glycan Conjugate Vaccines

“…The current primary clinical approach to reducing invasive GBS infection is intrapartum antimicrobial prophylaxis (IAP), involving the pre-administration of penicillin and macrolide antibiotics to pregnant women with GBS pathogens after being screened [ 5 , 10 , 11 , 12 ]. However, IAP only reduces early-onset disease (EOD) infections by more than 80% and is ineffective against late-onset disease (LOD) [ 5 , 10 , 13 ].…”

“…Additionally, there is an increasing resistance in GBS strains, and the use of antibiotics can disrupt the establishment of normal flora in newborns, impacting their normal development [ 5 , 10 ]. Maternal immunization with a GBS vaccine is considered a superior prevention strategy as it not only addresses the remaining burden of EOD and LOD but also prevents the stillbirths and premature births caused by GBS during pregnancy while avoiding early infant susceptibility to GBS threats [ 11 , 14 , 15 ]. Moreover, it reduces reliance on prophylactic antibiotics and minimizes antibiotic resistance concerns [ 14 , 15 ].…”

Neonatal Group BStreptococcusinfection at a single center in Al-Madinah Al-Munawarah, Saudi Arabia

“…This includes implementing and improving intrapartum antibiotic prophylaxis, given to carrier GBS pregnant women during delivery, and developing vaccines for maternal immunization during pregnancy. 7 - 9 …”

“…This includes implementing and improving intrapartum antibiotic prophylaxis, given to carrier GBS pregnant women during delivery, and developing vaccines for maternal immunization during pregnancy. [7][8][9] Knowing the epidemiology and risk factors for GBS provides data that could be used to estimate disease distribution in certain groups and geographical areas in Saudi Arabia and plan the development of appropriate GBS screening programs. At the the Maternity and Child Hospital, Al-Madinah Al-Munawarah, Saudi Arabia, where the study was carried out, the screening for GBS was carried out for high risk cases.…”