The burden of infant group B streptococcal infections in Ontario: Analysis of administrative data to estimate the potential benefits of new vaccines

Abstract

Group B streptococcus (GBS) is a leading bacterial cause of neonatal sepsis and meningitis in many countries as well as an important cause of disease in pregnant women. Currently, serotype-specific conjugate vaccines are being developed. We conducted an epidemiological analysis of health administrative data to estimate the burden of infant GBS disease in Ontario, Canada and combined these estimates with literature on serotype distribution to estimate the burden of disease likely to be vaccine-preventable. Between 1st January 2005 and 31st December 2015, 907 of 64320 health care encounters in Ontario in patients under 1 year old had codes specifically identifying GBS as the cause of the disease, of which 717 were under one month of age. In addition, application of epidemiological data to the remaining patients allowed us to estimate a further 2322 cases and among them 1822 were under one month of age. In the same period, 579 confirmed neonatal invasive GBS cases in patients up to one month of age were reported to public health. Depending on serotype distribution, vaccination coverage and early versus late onset disease (0-6 days and 7-90 days of age respectively), the preventable fraction ranged widely. With a vaccine that is 90% effective and 60% immunization coverage, up to 52% of early and late onset disease could be prevented by forthcoming vaccines. GBS is under-reported in Ontario. Uncertainty about the potential impact of vaccine indicates that further analysis and research may be needed to prepare for policy-decision making, including clinical validation studies and an economic evaluation of GBS vaccination in Ontario.

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

“…An obviously decreased GBS sepsis-attributable mortality rate has been reported in recent decades, from more than 20% in the 1980s to approximately 10.7% in recent studies [ 3 , 4 , 5 , 26 , 27 ]. The overall mortality rate in our cohort was compatible with recent studies [ 3 , 4 , 5 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] and a reduction in mortality between 2012 and 2020 was observed in our cohort. As reported in recent studies, multiple factors may account for the reduced mortality rate, including widespread implementation of antibiotics in at-risk mothers and babies and advances in managing acutely ill neonates [ 33 , 34 ].…”

“…Although serotype III/ST-17 GBS isolates accounted for more than half of all neonates with complicated GBS sepsis and meningitis, serotype Ib/CC12 GBS isolates were significantly more likely to cause complicated GBS sepsis ( Figure 1 ). Similar to recent studies, the increasing trend of serotype III/CC17 GBS predominance and antibiotic resistance rate among neonatal invasive diseases were noted in the past two decades [ 3 , 4 , 5 , 26 , 27 , 28 ]. After multivariate logistic regression analysis, respiratory failure requiring intubation and thrombocytopenia were independently associated with final adverse outcomes.…”

“…Although cases of neonatal GBS sepsis have significantly increased since 2012, which may be due to the expansion of referrals from other local hospitals in Taiwan, the case numbers and incidence rate of neonatal GBS sepsis have declined since 2018, which can be explained by the universal GBS screening and IAP in all local hospitals in Taiwan. Recent studies have found an increasing incidence of LOD [ 3 , 26 , 27 , 28 ], but most of them only enrolled cases of neonatal invasive GBS diseases until 2014 or 2015 [ 2 , 3 , 4 , 5 , 26 , 27 , 28 , 29 , 30 ]. Some updated information had data on GBS surveillance until 2017 or 2018 [ 31 , 32 , 33 ], while this report is one of the very few studies that enrolled neonatal invasive GBS diseases until 2020.…”

<p>Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study</p>

“…23 In addition to clinical investigations, home-time may potentially be used in other applications such as quality measurement and policymaking in healthcare considering that administrative claims databases have been commonly used in these fields. [24][25][26] For example, healthcare providers and consumers can compare the quality of stroke care across hospitals using home-time as a proxy indicator.…”