Revisiting the Need for Vaccine Prevention of Late-Onset Neonatal Group B Streptococcal Disease

Jordan, Hannah; Farley, Monica M.; Craig, Allen S.; Mohle-Boetani, Janet C.; Harrison, Lee H.; Petit, Susan; Lynfield, Ruth; Thomas, Ann; Zansky, Shelley; Gershman, Kenneth; Albanese, Bernadette; Schaffner, William; Schrag, Stephanie J.

doi:10.1097/inf.0b013e318180b3b9

Cited by 178 publications

(108 citation statements)

References 38 publications

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“…GBS conjugate vaccines that are being developed to prevent invasive disease may protect only against serotypes Ia, Ib, II, III, and V. Although a pentavalent vaccine that includes the more common serotypes is expected to provide protection for a high percentage of GBS cases (3,20,38), the global presence of type IV and the possibility of shifts in serotype predominance due to serotype replacement, capsular switch, or changes in bacterial virulence factors (1,9,31,40,49) necessitate ongoing surveillance of types IV and VI to VIII and the newly proposed type IX (46). Because of the emergence of invasive disease due to type IV in Minnesota, Boston, and other regions of the United States (16,27,39,45), monitoring of type IV colonization and disease in the population is warranted. If the prevalence of type IV in invasive disease significantly increases, this polysaccharide and/or associated GBS virulence proteins should be included in vaccine design (33,49).…”

Section: Discussionmentioning

confidence: 99%

Clonal Analysis of Colonizing Group B Streptococcus , Serotype IV, an Emerging Pathogen in the United States

et al. 2010

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Colonizing group B Streptococcus (GBS) capsular polysaccharide (CPS) type IV isolates were recovered from vaginal and rectal samples obtained from 97 (8.4%) nonpregnant women of 1,160 women enrolled in a U.S. multicenter GBS vaccine study from 2004 to 2008. Since this rate was much higher than the rate of prevalence of 0.4 to 0.6% that we found in previous studies, the isolates were analyzed by using surface protein profile identification, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) to characterize them and identify trends in DNA clonality and divergence. Of the 101 type IV isolates studied, 53 expressed ␣ and group B protective surface (BPS) proteins, 27 expressed BPS only, 20 expressed ␣ only, and 1 had no detectable surface proteins. The isolates spanned three PFGE macrorestriction profile groups, groups 37, 38, and 39, of which group 37 was predominant. The isolates in group 37 expressed the ␣ and BPS proteins, while those in groups 38 and 39 expressed the ␣ protein only, with two exceptions. MLST studies of selective isolates from the four protein profile groups showed that isolates expressing ␣,BPS or BPS only were of a new sequence type, sequence type 452, while those expressing ␣ only or no proteins were mainly of a new sequence type, sequence type 459. Overall, our study revealed a limited diversity in surface proteins, MLST types, and DNA macrorestriction profiles for type IV GBS. There appeared to be an association between the MLST types and protein expression profiles. The increased prevalence of type IV GBS colonization suggested the possibility that this serotype may emerge as a GBS pathogen.

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Section: Discussionmentioning

confidence: 99%

Clonal Analysis of Colonizing Group B Streptococcus , Serotype IV, an Emerging Pathogen in the United States

et al. 2010

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“…After the widespread use of GBS antenatal screening and intrapartum antibiotic prophylaxis (IAP) of all GBS carriers, a more than 80% reduction in early onset have been observed [3,14]. Contrasting, the incidence of late onset has remained quite stable ranging from 0.25 to 0.5 per 1000 live births [1,4,7,8,10,15,16].…”

Section: Introductionmentioning

confidence: 99%

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Renzo

Melin²,

Berardi

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

156

135

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Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecologyobstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

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“…These findings indicate that a subset of preterm monocytes do not respond to GBS, a defect compounded by generalized weaker lymphocyte responses in newborns. Together these deficient responses may increase the susceptibility of preterm infants to GBS infection.Streptococcus agalactiae (group B streptococcus [GBS]) is the leading infectious cause of death in the newborn (17), causing both early-and late-onset neonatal sepsis (EOS and LOS), characterized by septicemia, shock, and meningitis (16,18,31). The proportion of infants surviving extreme prematurity is increasing (11), and as a result preterm delivery is now the leading cause of neonatal morbidity and mortality.…”

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confidence: 99%

Preterm Infants Have Deficient Monocyte and Lymphocyte Cytokine Responses to Group B Streptococcus

et al. 2011

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Group B streptococcus (GBS) is an important cause of early-and late-onset sepsis in the newborn. Preterm infants have markedly increased susceptibility and worse outcomes, but their immunological responses to GBS are poorly defined. We compared mononuclear cell and whole-blood cytokine responses to heat-killed GBS (HKGBS) of preterm infants (gestational age [GA], 26 to 33 weeks), term infants, and healthy adults. We investigated the kinetics and cell source of induced cytokines and quantified HKGBS phagocytosis. HKGBSinduced tumor necrosis factor (TNF) and interleukin 6 (IL-6) secretion was significantly impaired in preterm infants compared to that in term infants and adults. These cytokines were predominantly monocytic in origin, and production was intrinsically linked to HKGBS phagocytosis. Very preterm infants (GA, <30 weeks) had fewer cytokine-producing monocytes, but nonopsonic phagocytosis ability was comparable to that for term infants and adults. Exogenous complement supplementation increased phagocytosis in all groups, as well as the proportion of preterm monocytes producing IL-6, but for very preterm infants, responses were still deficient. Similar defective preterm monocyte responses were observed in fresh whole cord blood stimulated with live GBS. Lymphocyte-associated cytokines were significantly deficient for both preterm and term infants compared to levels for adults. These findings indicate that a subset of preterm monocytes do not respond to GBS, a defect compounded by generalized weaker lymphocyte responses in newborns. Together these deficient responses may increase the susceptibility of preterm infants to GBS infection.Streptococcus agalactiae (group B streptococcus [GBS]) is the leading infectious cause of death in the newborn (17), causing both early-and late-onset neonatal sepsis (EOS and LOS), characterized by septicemia, shock, and meningitis (16,18,31). The proportion of infants surviving extreme prematurity is increasing (11), and as a result preterm delivery is now the leading cause of neonatal morbidity and mortality. Preterm infants are exquisitely susceptible to both EOS and LOS; they suffer approximately a quarter of invasive GBS EOS cases and half of GBS LOS cases, with a Ͼ8-fold-greater mortality for EOS and 3-fold for LOS compared to term infants (29). While a proportion of the increased susceptibility to infection in preterm infants relates to the absence of passively acquired maternal IgG antibody, deficiencies in the early immune response to bacterial pathogens likely play a critical role (23). Several studies have addressed neonatal adaptive and humoral immune responses, such as complement activation and antibody production, but there has been little focus on innate immunity to bacterial pathogens and its relation to adaptive responses in this population (23,39).Innate immunity provides the first line of defense against bacterial infection and is therefore particularly important in the neonatal period (9). Additionally, the innate immune system, through activation of specif...

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Revisiting the Need for Vaccine Prevention of Late-Onset Neonatal Group B Streptococcal Disease

Abstract: The late-onset GBS disease burden remains substantial. A trivalent vaccine could be an effective prevention strategy. Because many cases were born preterm, reducing the opportunity for transplacental antibody transfer, adolescent immunization should be considered.

Cited by 178 publications

References 38 publications

Clonal Analysis of Colonizing Group B Streptococcus , Serotype IV, an Emerging Pathogen in the United States

Clonal Analysis of Colonizing Group B Streptococcus , Serotype IV, an Emerging Pathogen in the United States

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Preterm Infants Have Deficient Monocyte and Lymphocyte Cytokine Responses to Group B Streptococcus

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