Incidence and serotype distribution of invasive group B streptococcal disease in young infants: a multi-country observational study

Abstract

BackgroundGroup B Streptococcus (GBS) is a leading cause of serious infection in very young infants. Robust incidence data from many geographic regions, including Latin America and Asia, are however lacking.MethodsA multicenter, hospital-based observational study was performed in Panama, Dominican Republic, Hong Kong and Bangladesh. All represented urban, tertiary referral hospitals, except Bangladesh. GBS cases (microbiological isolation from normally sterile sites in infants aged 0–89 days) were collected over 12 months.ResultsAt 2.35 (95 % CI: 1.74–3.18) cases per 1000 live births, the incidence of early onset GBS disease (EOD) was highest in the Dominican Republic, compared with 0.76 (95 % CI: 0.41–1.39) in Hong Kong and 0.77 (95 % CI: 0.44–1.35) in Panama, while no cases were identified in Bangladesh. Over 90 % of EOD cases occurred on the first day of life, with case fatality ratios ranging from 6.7 % to 40 %, varying by center, age of onset and clinical presentation. Overall, 90 % of GBS (EOD and late onset disease) was due to serotypes Ia, Ib and III.ConclusionsThe incidence rate of early onset GBS infection reported in Dominican Republic was not dissimilar from that described in the United States prior to screening and intrapartum antibiotic prophylaxis, while the incidence in Hong Kong was higher than previously reported in the Asian region. The failure to identify GBS cases in Bangladesh highlights a need to better understand the contribution of population, healthcare and surveillance practice to variation in reported incidence. Overall, the identified disease burden and serotype distribution support the need for effective prevention methods in these populations, and the need for community based surveillance studies in rural areas where access to healthcare may be challenging.

Group B Streptococci Colonization in Pregnant Guatemalan Women: Prevalence, Risk Factors, and Vaginal Microbiome

“…However, even if only 2 of the cases of EOS identified among our cohort of neonates are due to GBS, this gives an incidence rate 2.23 cases per 1000 live births. These estimates are comparable to a recent study identifying an early-onset GBS incidence rate of 2.35 per 1000 live births in the Dominican Republic [29]. Our findings suggest that GBS may be a significant contributor to neonatal morbidity and mortality in Guatemala.…”

Epidemiology of invasive group B streptococcal disease in infants from urban area of South China, 2011–2014

“…Knowledge of the serotype is crucial to the development of serotype-based vaccines against GBS disease. Serotype distribution varies by country and region [ 24 , 25 ], with serotype III predominating worldwide [ 5 , 10 , 26 , 27 ]. It is well comparable to the results of our study.…”

Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

“…Case fatality ratios reported in hospital-based studies from sub-Saharan Africa have ranged from 20% to 38% 22 , 24 , 25 , with higher case fatality among preterm infants 24 . A multi-country observational study conducted in Panama, Dominican Republic, and Hong Kong showed that the average number of days hospitalized ranged from 6 (Dominican Republic) to 15 (Hong Kong), with case fatality ratios ranging from 10% (Hong Kong) to 33% (Dominican Republic) 34 . Case fatality ratios in resource rich settings are notably lower ( e.g ., United States: 4–6%), yet a study from the United States reported a nearly eight times higher risk of death among preterm cases compared to term cases 35 .…”