Ritual Immersion in a Mikveh Is Associated with Increased Risk of Group B Streptococcal Carrier State in Israeli Parturient Women

Abstract

Purpose: Group B Streptococcus (GBS) infection is a major cause of neonatal sepsis. The objective of this study was to estimate the prevalence and risk factors for GBS carriership among parturient women in Jerusalem. Methods: A cross-sectional study of 436 parturient Jewish women at Hadassah-Hebrew University Medical Center, Mount Scopus. The study included patient interview and vagino-rectal swab for culture. Main outcome measures were the prevalence of GBS carriership among study population. Results: Of the 436 participants, 77 had a positive culture for GBS, giving a carrier rate of 17.7%. No differences were found between carriers and non-carriers in age, BMI or parity. Orthodox Jewish women had a significantly higher carrier rate compared with secular Jewish women (20.6% vs. 12.8% respectively), yielding an age, education and BMI adjusted odds ratio (OR) of 1.9 (95% confidence interval (CI): 1.06 -3.40). Similarly, ritual immersion was associated with increased risk of carrier state with an adjusted OR of 2.01 (95% CI: 1.03 -3.92, P = 0.039). Conclusions: Our study suggests an association between ritual immersion in the Mikveh and GBS carriership.

Group B Streptococcus serotypes associated with different clinical syndromes: Asymptomatic carriage in pregnant women, intrauterine fetal death, and early onset disease in the newborn

“…[ 27 ]. A previous study demonstrated a significantly higher GBS carriage rate in Orthodox non pregnant Jewish women compared with secular Jewish non pregnant women (20.6% vs. 12.8% respectively) [ 28 ]. Orthodox Jews usually live in closed, small living areas [ 27 , 29 ].…”

“…In Orthodox Jews marriages are mostly within the community, and women tend to give birth to more children compared to the mean number of children in the general Israeli population (7.1 compare to 3.1, respectively, data from the Israeli Central Bureau of Statistics). A previous study in Israel tried to connect between increased rates of GBS among orthodox Jewish pregnant women and ritual immersions in a Mikveh [ 28 ]. In the Orthodox Jewish patients that MHMC caters to, the high rate of GBS carriage may be related to social or religious practices such as the Mikveh, or close living quarters.…”

Are Mikvehs Responsible for GBS Carriers among Orthodox Jewish Women?—A Prospective Observational Study

“…In contrast to the large increase in the prevalence of GBS carriers, the prevalence of early-onset sepsis (EOS) due to GBS among the babies born to mothers with a risk factors for EOS decreased from 0.71/1000 births to 0.52/1000 births, and from 0.33/1000 births to 0.18/1000 births in 2016 among the babies without a maternal risk factor for EOS [7]. Concerns about a correlation between the increase in GBS carriers and maternal ritual bathing in mikvehs have risen since Drai-Hasid et al's publication [10]. In contrast to the former study by Drai-Hasid et al, who suggested an Open Journal of Obstetrics and Gynecology association between ritual immersion in Mikvehs and GBS carriership according to a cross-sectional survey from 436 parturient Jewish women from Jerusalem, we in a prospective manner, tested cultures for GBS in the Mikvehs and not the GBS status of the mothers.…”

“…Non-pregnant orthodox Jewish women attend a mikveh each month approximately for 14 days since the onset of menses. In 2015, Drai-Hasid et al reported that immersion in a mikveh pool is a risk factor for GBS colonization [10]. We questioned the validity of that claim since the chloride used to sanitize the water in mikveh pools is the same as that used in swimming pools.…”