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Novel Multiplex Immunoassays for Quantification of IgG against Group B Streptococcus Capsular Polysaccharides in Human Sera. mSphere 2019; 4:4/4/e00273-19. [PMID: 31391276 PMCID: PMC6686225 DOI: 10.1128/msphere.00273-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS) infections constitute a major cause of invasive disease during the first three months of life and an unmet medical need that could be addressed by maternal vaccination. The GBS capsular polysaccharides (CPSs) have shown promise as vaccine targets in clinical studies. A highly specific serological assay to quantify maternal and neonatal anti-CPS antibody levels will be instrumental for GBS vaccine licensure. Here, we describe the development and comparison of two novel multiplex immunoassays (MIAs) based on the Luminex technology for the quantification of IgG antibodies recognizing the five most frequent GBS capsular variants (Ia, Ib, II, III, and V) out of the ten types identified. The first assay is based on the use of biotinylated CPSs coupled to streptavidin-derivatized magnetic microspheres (Biotin-CPS MIA), while the second is a sandwich assay with plain CPSs coupled to magnetic microspheres coated with polysaccharide-specific mouse monoclonal antibodies (Sandwich MIA). Both assays showed good specificity, linearity, and precision, although the Biotin-CPS MIA presented higher sensitivity and lower complexity than the Sandwich MIA. A panel of human sera representing a wide range of anti-CPS IgG concentrations was tested in parallel by the two assays, which resulted in comparable titers. Our data support the preservation of antigenic epitopes in the biotinylated polysaccharides and the suitability of the Biotin-CPS MIA for the precise determination of GBS anti-CPS IgG concentrations in human sera.IMPORTANCE Group B streptococcal infections can cause death in neonates up to 3 months of age. Intrapartum antibiotic prophylaxis in GBS-colonized mothers has limited early infections but has no impact after the first week of life. The development of a maternal vaccine to address this unmet medical need has been identified as a priority by the World Health Organization, and the GBS CPSs are considered the best antigen targets. However, to date there are no accepted standardized assays to measure immune responses to the investigational vaccines and for establishment of serocorrelates of protection. Here, we describe the performance of two microsphere-based pentaplex immunoassays for the determination of antibodies recognizing the five most frequent GBS serotypes. Our data confirm that an assay based on biotinylated polysaccharides coupled to streptavidin microspheres would be suitable for the intended purpose.
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Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams-Chapman I, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Mowitz M, Watterberg K, Maldonado YA, Zaoutis TE, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Kourtis AP, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Sawyer MH, Steinbach WJ, Zangwill K. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019; 144:peds.2019-1881. [PMID: 31285392 DOI: 10.1542/peds.2019-1881] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS early-onset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection. This clinical report is endorsed by the American College of Obstetricians and Gynecologists (ACOG), July 2019, and should be construed as ACOG clinical guidance.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota; and
| | - James J. Cummings
- Departments of Pediatrics and Bioethics, Alden March Bioethics Institute, Albany Medical College, Albany, New York
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Tapiainen T, Koivusaari P, Brinkac L, Lorenzi HA, Salo J, Renko M, Pruikkonen H, Pokka T, Li W, Nelson K, Pirttilä AM, Tejesvi MV. Impact of intrapartum and postnatal antibiotics on the gut microbiome and emergence of antimicrobial resistance in infants. Sci Rep 2019; 9:10635. [PMID: 31337807 PMCID: PMC6650395 DOI: 10.1038/s41598-019-46964-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/08/2019] [Indexed: 12/24/2022] Open
Abstract
Altogether, 20-30% of women receive intrapartum antibiotic prophylaxis (IAP) to prevent sepsis in infants and 2-5% of newborn infants receive antibiotics due to suspected sepsis. Caesarean section has a long-term impact on the intestinal microbiome but the effects of perinatal antibiotics on gut microbiome in vaginally delivered infants are not well known. We compared the impact of IAP, postnatal antibiotics, or their combination on the gut microbiome and emergence of antimicrobial resistance in a controlled study of 149 newborn infants recruited within 24 hours after birth. We collected 659 fecal samples, including 426 daily samples from infants before discharge from the hospital and 111 follow-up samples at six months. Penicillin was mostly used for IAP and the combination of penicillin and aminoglycoside for postnatal treatment. Postnatal antibiotic groups received Lactobacillus reuteri probiotic. Newborn gut colonization differed in both IAP and postnatal antibiotics groups as compared to that in control group. The effect size of IAP was comparable to that caused by postnatal antibiotics. The observed differences were still present at six months and not prevented by lactobacilli consumption. Given the present clinical results, the impact of perinatal antibiotics on the subsequent health of newborn infants should be further evaluated.
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Affiliation(s)
- Terhi Tapiainen
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90029, Oulu, Finland. .,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, 90014, Finland.
| | - Pirjo Koivusaari
- Ecology and Genetics, Faculty of Science, University of Oulu, Oulu, 90014, Finland
| | | | | | - Jarmo Salo
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90029, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, 90014, Finland
| | - Marjo Renko
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90029, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, 90014, Finland.,University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Hannele Pruikkonen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, 90014, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescence, Oulu University Hospital, 90029, Oulu, Finland.,PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, 90014, Finland
| | - Weizhong Li
- J. Craig Venter Institute, La Jolla, CA, 92037, USA
| | - Karen Nelson
- J. Craig Venter Institute, Rockville, MD, 28050, USA
| | | | - Mysore V Tejesvi
- Ecology and Genetics, Faculty of Science, University of Oulu, Oulu, 90014, Finland
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Emerging serotype III sequence type 17 group B streptococcus invasive infection in infants: the clinical characteristics and impacts on outcomes. BMC Infect Dis 2019; 19:538. [PMID: 31216993 PMCID: PMC6585028 DOI: 10.1186/s12879-019-4177-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is an important pathogen that causes high mortality and morbidity in young infants. However, data on clinical manifestations between different GBS serotypes and correlation with molecular epidemiology are largely incomplete. The aim of this study was to determine the serotype distribution, antimicrobial resistance, clinical features and molecular characteristics of invasive GBS isolates recovered from Taiwanese infants. METHODS From 2003 to 2017, 182 non-duplicate GBS isolates that caused invasive disease in infants less than one year of age underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. The clinical features of these infants with GBS disease were also reviewed. RESULTS Of the 182 patients with invasive GBS disease, 41 (22.5%) were early-onset disease, 121 (66.5%) were late-onset disease and 20 (11.0%) were late late-onset disease (> 90 days of age). All these patients were treated with effective antibiotics on time. Among them, 51 (28.0%) had meningitis, 29 (16.0%) had neurological complications, 12 (6.6%) died during hospitalization, and 15 (8.8%) out of 170 patients who survived had long-term neurological sequelae at discharge. Serotype III GBS strains accounted for 64.8%, followed by serotype Ia (18.1%) and Ib (8.2%). MLST analysis revealed 11 different sequence types among the 182 isolates and ST-17 was the most dominant sequence type (56.6%). The correlation between serotype III and ST17 was evident, as ST17 accounted for 87.3% of all serotype III isolates. There was an obvious increasing trend of type III/ST-17 GBS that caused invasive disease in infants. All isolates were susceptible to penicillin, cefotaxime, and vancomycin, while 68.1 and 65.9% were resistant to erythromycin and clindamycin, respectively. CONCLUSIONS Despite timely and appropriate antibiotic treatment, a significant proportion of invasive GBS disease still inevitably causes adverse outcomes. Further study to explore preventive strategies and development of serotype-based vaccines will be necessary in the future.
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Abstract
Group B Streptococcus (GBS) is estimated to have caused 319,000 cases of neonatal disease resulting in 90,000 infant deaths globally in 2015. It is also associated with maternal sepsis, preterm births, stillbirths and neonatal encephalopathy. There is a significant burden of neurologic impairment among survivors of infant GBS disease. Intrapartum antibiotic prophylaxis strategies have reduced the incidence of newborn early-onset GBS (occurring days 0-6) in some settings, but they are not feasible in many low and middle-income countries. A maternal vaccine given to pregnant women to stimulate passive transplacental transfer of protective antibodies has the potential to reduce maternal disease, adverse pregnancy outcomes and newborn disease. Phase I and II vaccine studies are occurring, but conducting phase III efficacy studies of a GBS vaccine candidate would require very large numbers due to the relatively low incidence of invasive GBS disease. It has therefore been proposed that alternative pathways to vaccine licensure should be explored, for example, through use of a regulatory approved correlate of protection and safety evaluation in mothers, fetuses and infants. These studies would then be followed-up with post-licensure phase IV studies in which vaccine effectiveness is evaluated.
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256
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Collin SM, Shetty N, Guy R, Nyaga VN, Bull A, Richards MJ, van der Kooi TI, Koek MB, De Almeida M, Roberts SA, Lamagni T. Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. Int J Infect Dis 2019; 83:116-129. [DOI: 10.1016/j.ijid.2019.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
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Comparison of Three Nucleic Acid Amplification Tests and Culture for Detection of Group B Streptococcus from Enrichment Broth. J Clin Microbiol 2019; 57:JCM.01958-18. [PMID: 30944190 PMCID: PMC6535594 DOI: 10.1128/jcm.01958-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/16/2019] [Indexed: 12/17/2022] Open
Abstract
Colonization of the gastrointestinal and genitourinary tracts of pregnant women with group B Streptococcus (GBS) can result in vertical transmission to neonates during labor/delivery. GBS infections in neonates can cause severe complications, such as sepsis, meningitis, and pneumonia. Accurate detection is critical because administration of intrapartum antibiotics can significantly reduce transmission. We compared the clinical sensitivities of three nucleic acid amplification tests (NAATs), the Hologic Panther Fusion GBS, Luminex Aries GBS, and Cepheid Xpert GBS LB assays, to that of the standard of care culture method recommended for GBS screening using 500 vaginal-rectal swab specimens after 18 to 24 h of broth enrichment. We identified 108 positive specimens (21.6%) by culture, while at least 1 of the 3 NAATs was positive for GBS in 155 specimens (31.0%). All 108 specimens positive by culture were also detected by the Panther Fusion assay, while 107/108 (99.1%) were detected by the Cepheid Xpert and Luminex Aries assays. Of the 61 specimens positive by at least 1 NAAT but negative by culture, 24 (39.3%) were positive by all 3 NAATs, suggesting that they represent true positives (TPs). NAATs offer less hands-on time, greater throughput, faster time to result, and potentially greater sensitivity than culture methods, and they should be considered the new gold standard for intrapartum GBS screening.
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258
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Clouse K, Shehabi A, Suleimat AM, Faouri S, Khuri-Bulos N, Al Jammal A, Chappell J, Fortner KB, Chamby AB, Randis TM, Ratner AJ, Aronoff DM, Halasa N. High prevalence of Group B Streptococcus colonization among pregnant women in Amman, Jordan. BMC Pregnancy Childbirth 2019; 19:177. [PMID: 31109301 PMCID: PMC6528311 DOI: 10.1186/s12884-019-2317-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Little is known of the burden of Group B Streptococcus (GBS) colonization among pregnant women in Jordan. We conducted a pilot study to determine the prevalence of GBS among pregnant women in Amman, Jordan, where GBS testing is not routine. We also explored GBS serotypes and the performance of a rapid GBS antigen diagnostic test. Methods We collected vaginal-rectal swabs from women who presented for labor and delivery at Al-Bashir Hospital. Three methods were used to identify GBS: Strep B Rapid Test (Creative Diagnostics), blood agar media (Remel) with confirmed with BBL Streptocard acid latex test (Becton Dickinson), and CHROMagar StrepB (Remel). Results were read by a senior microbiologist. We defined our gold standard for GBS-positive as a positive blood agar culture confirmed by latex agglutination and positive CHROMagar. PCR testing determined serotype information. Demographic and clinical data were also collected. Results In April and May 2015, 200 women were enrolled with a median age of 27 years (IQR: 23–32); 89.0% were Jordanian nationals and 71.9% completed secondary school. Median gestational age was 38 weeks (IQR: 37–40); most women reported prenatal care (median 9 visits; IQR: 8–12). Median parity was 2 births (IQR: 1–3). Pre-pregnancy median BMI was 24.1 (IQR: 21.5–28.0) and 14.5% reported an underlying medical condition. Obstetric complications included gestational hypertension (9.5%), gestational diabetes (6.0%), and UTI (53.5%), of which 84.5% reported treatment. Overall, 39 (19.5%) of women were GBS-positive on blood agar media and CHROMagar, while 67 (33.5%) were positive by rapid test (36% sensitivity, 67% specificity). Serotype information was available for 25 (64%) isolates: III (48%), Ia (24%), II (20%), and V (8%). No demographic or clinical differences were noted between GBS+ and GBS-negative women. Conclusions Nearly one in five women presenting for labor in Jordan was colonized with GBS, with serotype group III as the most common. The rapid GBS antigen diagnostic had low sensitivity and specificity. These results support expanded research in the region, including defining GBS resistance patterns, serotyping information, and risk factors. It also emphasizes the need for routine GBS testing and improved rapid GBS diagnostics for developing world settings.
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Affiliation(s)
- Kate Clouse
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Global Health, Nashville, TN, USA.
| | | | | | | | | | | | - James Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly B Fortner
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna B Chamby
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - Tara M Randis
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - Adam J Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, NY, USA
| | - David M Aronoff
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natasha Halasa
- Vanderbilt Institute for Global Health, Nashville, TN, USA. .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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259
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de Gier B, van Kassel MN, Sanders EAM, van de Beek D, Hahné SJM, van der Ende A, Bijlsma MW. Disease burden of neonatal invasive Group B Streptococcus infection in the Netherlands. PLoS One 2019; 14:e0216749. [PMID: 31071191 PMCID: PMC6508726 DOI: 10.1371/journal.pone.0216749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis worldwide. We aimed to estimate the current burden of neonatal invasive GBS disease in the Netherlands, as a first step in providing an evidence base for policy makers on the potential benefits of a future maternal GBS vaccine. METHODS Surveillance of neonatal invasive GBS occurs at the National Reference Laboratory for Bacterial Meningitis, where culture isolates from cerebrospinal fluid and blood are sent by diagnostic laboratories. From the number of cultures we estimated the incidence of neonatal (age 0-90 days) GBS meningitis and sepsis. We constructed a disease progression model informed by literature and expert consultation to estimate the disease burden of neonatal invasive GBS infection. As many neonates with a probable GBS sepsis are never confirmed by blood culture, we further estimated the disease burden of unconfirmed cases of probable GBS sepsis in sensitivity analyses. RESULTS An estimated 97 cases and 6.5 deaths occurred in the Netherlands in 2017 due to culture positive neonatal invasive GBS infection. This incidence comprised 15 cases of meningitis and 42 cases of sepsis per 100.000 births, with an estimated mortality of 3.8 per 100.000 live births. A disease burden of 780 disability-adjusted life years (DALY) (95% CI 650-910) or 460 DALY per 100.000 live births was attributed to neonatal invasive GBS infection. In the sensitivity analysis including probable neonatal GBS sepsis the disease burden increased to 71 cases and 550 DALY (95% CI 460-650) per 100.000 live births. CONCLUSION In conclusion, neonatal invasive GBS infection currently causes a substantial disease burden in the Netherlands. However, important evidence gaps are yet to be filled. Furthermore, cases of GBS sepsis lacking a positive blood culture may contribute considerably to this burden potentially preventable by a future GBS vaccine.
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Affiliation(s)
- Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- * E-mail:
| | - Merel N. van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Elisabeth A. M. Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Susan J. M. Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology and the Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Merijn W. Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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260
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Soto JA, Diaz-Dinamarca DA, Soto DA, Barrientos MJ, Carrión F, Kalergis AM, Vasquez AE. Cellular immune response induced by surface immunogenic protein with AbISCO-100 adjuvant vaccination decreases group B Streptococcus vaginal colonization. Mol Immunol 2019; 111:198-204. [PMID: 31078966 DOI: 10.1016/j.molimm.2019.04.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022]
Abstract
Group B Streptococcus (GBS) represents one of the most common causes of bacterial infection in neonates; it is also associated with premature childbirth and stillbirth. A vaccine against GBS is needed, but no approved vaccines are yet available. The Surface Immunogenic Protein (SIP) of GBS is conserved in all serotypes and had been reported to be a good vaccine prototype in a mouse model of GBS infection. Also, we have previously shown that both subcutaneous and oral immunization with rSIP can induce an efficient immune response that decreases GBS vaginal colonization in mice. In this study, we show that a vaccine based on a mixture of rSIP and AbISCO-100 adjuvant reduces GBS vaginal colonization in mice and induces antibodies with opsonophagocytic activities. Moreover, the passive transfer of sera and total T-cells from mice immunized with rSIP mixed with AbISCO-100 to unvaccinated mice decreases vaginal GBS colonization in an infected mouse. This is the first report of cellular immunity associated with rSIP-based vaccine testing in a mouse model of GBS infection.
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Affiliation(s)
- Jorge A Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego A Diaz-Dinamarca
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel A Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Magaly J Barrientos
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Flavio Carrión
- Programa de Inmunología Trasnacional, Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Abel E Vasquez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile; Facultad de Medicina y Ciencia, Universidad San Sebastián. Providencia, Santiago, Chile.
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261
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Affiliation(s)
- Richard A Stein
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Health, New York, NY
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262
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Abstract
Invasive disease due to group B Streptococcus infection (Streptococcus agalactiae) results in a wide spectrum of clinical disease. In North America, serotypes Ia, Ib, II, III, and V are most frequently associated with invasive disease. Group B Streptococcus remains a continuing source of morbidity and mortality in high-risk populations, including pregnant women, neonates, and the elderly; an increasing incidence of invasive disease has been observed in nonpregnant adults. Group B Streptococcus remains the most common culture-confirmed neonatal bacterial infection in the United States and is a significant source of neonatal morbidity globally. Intrapartum antibiotic prophylaxis has reduced the incidence of early-onset neonatal disease without a notable impact on the incidence of late-onset neonatal disease. Penicillin G remains the mainstay of therapy, although reduced penicillin susceptibility has been observed in select isolates. Increased frequency of resistance to non-beta-lactam antibiotics, including clindamycin, erythromycin, and fluoroquinolones, has been observed, with some isolates demonstrating resistance to vancomycin. The development and implementation of strategies to identify hosts, treat judiciously with antimicrobials with the narrowest spectra, and prevent invasive disease, with vaccines, are essential to reduce the burden of group B Streptococcus disease.
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The role of immune correlates of protection on the pathway to licensure, policy decision and use of group B Streptococcus vaccines for maternal immunization: considerations from World Health Organization consultations. Vaccine 2019; 37:3190-3198. [PMID: 31031031 PMCID: PMC6528168 DOI: 10.1016/j.vaccine.2019.04.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 12/27/2022]
Abstract
There is a major public health need for GBS vaccines for maternal immunization. Important obstacles lie in the way of a pivotal clinical efficacy trial for licensure. A vaccine development pathway based on an immune correlate of protection is envisaged. Key considerations and priority activities for success are presented, based on WHO consultations.
The development of a group B Streptococcus (GBS) vaccine for maternal immunization constitutes a global public health priority, to prevent GBS-associated early life invasive disease, stillbirth, premature birth, maternal sepsis, adverse neurodevelopmental consequences, and to reduce perinatal antibiotic use. Sample size requirements for the conduct of a randomized placebo-controlled trial to assess vaccine efficacy against the most relevant clinical endpoints, under conditions of appropriate ethical standards of care, constitute a significant obstacle on the pathway to vaccine availability. Alternatively, indirect evidence of protection based on immunologic data from vaccine and sero-epidemiological studies, complemented by data from opsonophagocytic in vitro assays and animal models, could be considered as pivotal data for licensure, with subsequent confirmation of effectiveness against disease outcomes in post-licensure evaluations. Based on discussions initiated by the World Health Organization we present key considerations about the potential role of correlates of protection towards an accelerated pathway for GBS vaccine licensure and wide scale use. Priority activities to support progress to regulatory and policy decision are outlined.
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264
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Furfaro LL, Nathan EA, Chang BJ, Payne MS. Group B streptococcus prevalence, serotype distribution and colonization dynamics in Western Australian pregnant women. J Med Microbiol 2019; 68:728-740. [PMID: 31013212 DOI: 10.1099/jmm.0.000980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Streptococcus agalactiae, or group B streptococcus (GBS), is a leading neonatal pathogen that causes sepsis, meningitis and pneumonia. Globally, strategies have been implemented to address vertical transmission, and in Western Australia (WA), culture-based screening at 35-37 weeks' gestation is part of routine care and guides antibiotic administration. Previous Australian studies have focused on other regions or included low sample-size representatives; we aimed to describe antenatal GBS colonization in WA. METHODOLOGY A cohort of 814 pregnant women attending antenatal clinics (2015-2017) self-collected vaginal and rectal swabs at ≤22 weeks (n=814) and ≥33 weeks' (n=567) gestation. These were assessed for GBS presence using culture and PCR, and serotyping was conducted using molecular methods. Lifestyle questionnaires and medical data were collected. RESULTS We observed an overall GBS colonization rate of 24%, with 10.6 % of positive participants transiently colonized. Ethnicity (Aboriginal, Torres Strait Islander and African), maternal age ≥25 years, vitamin use, frequent sexual intercourse (≥5 times/week) and use of sex toys were associated with GBS colonization. The dominant serotypes identified were Ia (27.9%), III (20.9%), II (16.3%), V (15.8%), Ib (8.4%), VI (5.1%), IV (2.8%), NT (1.9), VIII (0.5%) and IX (0.5%) at visit one, with V (18.9%) preceding serotype II (18.2%) at visit two. Serotype VII was not detected. CONCLUSION This is the first cohort study to assess GBS colonization in Western Australian pregnant women and will be highly beneficial for guiding clinical practice and future therapeutic options, in particular, the selection of suitable vaccine candidates.
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Affiliation(s)
- Lucy L Furfaro
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Australia
| | - Elizabeth A Nathan
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Australia.,Women and Infants Research Foundation of Western Australia, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Barbara J Chang
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Australia
| | - Matthew S Payne
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Australia
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265
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Ali MM, Woldeamanuel Y, Woldetsadik DA, Chaka TE, Fenta DA, Dinberu MT, Weldetensaye EK, Ismael SJ, Tadesse BT. Prevalence of group B streptococcus among pregnant women and newborns at Hawassa University comprehensive specialized hospital, Hawassa, Ethiopia. BMC Infect Dis 2019; 19:325. [PMID: 30991960 PMCID: PMC6469063 DOI: 10.1186/s12879-019-3859-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/28/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Group B streptococcus (GBS) is reported as the leading cause of neonatal sepsis and meningitis. Newborns from GBS colonized pregnant women are at high risk of infection. METHOD A Hospital based cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital from November 05, 2014 to March 25, 2015. A total of 280 pregnant women along with their newborns were screened for GBS using standard method recommended by Center of Disease Control and Prevention. GBS strains were serotyped by using serotype specific antisera. A structured questionnaire was used to collect sociodemographic, obstetrics and clinical data of pregnant women and newborns. Data was analyzed by using chi-square and logistic regression to determine factors associated with prevalence of GBS among pregnant women and newborns. Descriptive statistics was used to determine prevalence of GBS among pregnant women and newborns. P value less than 0.05 was considered statistically significant. RESULT Prevalence of GBS among pregnant women, newborns and vertical transmission rate at Hawassa University Comprehensive Specialized Hospital were 44(15.7%), 26(8.9%) and 59.1% respectively. Among 26 GBS colonized newborns one developed sign and symptoms of early onset disease. Serotype distribution of GBS isolates collected from pregnant women and newborns was Ia 13(18.6%), Ib 9(12.9%), II 24(34.3%), III 8(11.4%), V 14(20%), and NT 2 (2.9%). CONCLUSION In our study we found relatively high prevalence of GBS among pregnant women and vertical transmission rate. The most prevalent GBS serotypes identified in this study were serotype II followed by V, Ia and Ib. Therefore, appropriate prevention strategies such as intrapartum antibiotic prophylaxis and vaccine development should be considered.
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Affiliation(s)
- Musa Mohammed Ali
- School of Medical laboratory science, College of medicine and health science Hawassa University, Hawassa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Department of Microbiology, Immunology and Parasitology College of Health Science Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Asrat Woldetsadik
- Department of Microbiology, Immunology and Parasitology College of Health Science Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Demissie Assegu Fenta
- School of Medical laboratory science, College of medicine and health science Hawassa University, Hawassa, Ethiopia
| | - Muluwork Tefera Dinberu
- Department of Pediatrics, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eskinder Kebede Weldetensaye
- Department of Gynecology and Obstetrics, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samson Jamal Ismael
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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266
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Martín V, Cárdenas N, Ocaña S, Marín M, Arroyo R, Beltrán D, Badiola C, Fernández L, Rodríguez JM. Rectal and Vaginal Eradication of Streptococcus agalactiae (GBS) in Pregnant Women by Using Lactobacillus salivarius CECT 9145, A Target-specific Probiotic Strain. Nutrients 2019; 11:E810. [PMID: 30974819 PMCID: PMC6521265 DOI: 10.3390/nu11040810] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
Streptococcus agalactiae (Group B Streptococci, GBS) can cause severe neonatal sepsis. The recto-vaginal GBS screening of pregnant women and intrapartum antibiotic prophylaxis (IAP) to positive ones is one of the main preventive options. However, such a strategy has some limitations and there is a need for alternative approaches. Initially, the vaginal microbiota of 30 non-pregnant and 24 pregnant women, including the assessment of GBS colonization, was studied. Among the Lactobacillus isolates, 10 Lactobacillus salivarius strains were selected for further characterization. In vitro characterization revealed that L. salivarius CECT 9145 was the best candidate for GBS eradication. Its efficacy to eradicate GBS from the intestinal and vaginal tracts of pregnant women was evaluated in a pilot trial involving 57 healthy pregnant women. All the volunteers in the probiotic group (n = 25) were GBS-positive and consumed ~9 log10 cfu of L. salivarius CECT 9145 daily from week 26 to week 38. At the end of the trial (week 38), 72% and 68% of the women in this group were GBS-negative in the rectal and vaginal samples, respectively. L. salivarius CECT 9145 seems to be an efficient method to reduce the number of GBS-positive women during pregnancy, decreasing the number of women receiving IAP during delivery.
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Affiliation(s)
- Virginia Martín
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Nivia Cárdenas
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Sara Ocaña
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, 28040 Madrid, Spain.
- Unidad de Reproducción, Fundación Hospital Alcorcón, 28922 Alcorcón, Spain.
| | - María Marín
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Rebeca Arroyo
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain.
| | - David Beltrán
- Centro de Diagnóstico Médico, Ayuntamiento de Madrid, 28006 Madrid, Spain.
| | - Carlos Badiola
- Laboratorios Casen Recordati S.L., Vía de las Dos Castillas, 33, 28224 Pozuelo de Alarcón, Madrid, Spain.
| | - Leónides Fernández
- Department of Galenic Pharmacy and Food Technology, Complutense University of Madrid, 28040 Madrid, Spain.
| | - Juan M Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, 28040 Madrid, Spain.
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267
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Braye K, Foureur M, de Waal K, Jones M, Putt E, Ferguson J. Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016. PLoS One 2019; 14:e0214295. [PMID: 30946761 PMCID: PMC6448895 DOI: 10.1371/journal.pone.0214295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intrapartum antibiotic prophylaxis (IAP) to reduce the likelihood of neonatal early-onset group B streptococcal infection (EOGBS) has coincided with major reductions in incidence. While the decline has been largely ascribed to IAP following either universal screening or a risk-based approach to identify mothers whose babies may most benefit from IAP, there is lack of high quality evidence to support this view. AIMS To describe management of maternal GBS colonisation in one local health district using universal screening and assess rates of EOGBS over time. METHODS A retrospective cohort study was undertaken to describe compliance with GBS management, to determine the incidence of EOGBS and association between rates and maternal screening. Linking routinely collected maternity and pathology data, we explored temporal trends using logistic regression and covariates for potential effect modifiers. RESULTS Our cohort included 62,281 women who had 92,055 pregnancies resulting in 93,584 live born babies. Screening occurred in 76% of pregnancies; 69% had a result recorded, 21.5% of those were positive for GBS. Prophylaxis was used by 79% of this group. Eighteen babies developed EOGBS, estimated incidence/1000 live births in 2006 and 2016 was 0.35 (95% CI, 0.07 to 0.63) and 0.1 (95% CI, 0 to 0.2) respectively. Seven of 10 term babies with EOGBS were born to mothers who screened negative. Data were unable to provide evidence of difference in rates of EOGBS between screened and unscreened pregnancies. We estimated the difference in EOGBS incidence from crude and weighted models to be 0 (95% CI, -0. 2 to 0.17) and -0.01 (95% CI, -0.13 to 0.10) /1000 live births respectively. CONCLUSION No change was detected in rates of EOGBS over time and no difference in EOGBS in babies of screened and unscreened populations. Screening and prophylaxis rates were modest. Limitations of universal screening suggest alternatives be considered.
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Affiliation(s)
- Kathryn Braye
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Health, Newcastle, New South Wales, Australia
| | - Maralyn Foureur
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Health, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Koert de Waal
- Department of Neonatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark Jones
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Elise Putt
- Hunter New England Health, Newcastle, New South Wales, Australia
| | - John Ferguson
- Hunter New England Health, Newcastle, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
- New South Wales Health Pathology, Newcastle, New South Wales, Australia
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268
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Gizachew M, Tiruneh M, Moges F, Tessema B. Streptococcus agalactiae maternal colonization, antibiotic resistance and serotype profiles in Africa: a meta-analysis. Ann Clin Microbiol Antimicrob 2019; 18:14. [PMID: 30922308 PMCID: PMC6437888 DOI: 10.1186/s12941-019-0313-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/15/2019] [Indexed: 12/31/2022] Open
Abstract
Background Maternal rectovaginal colonization with Streptococcus agalactiae (Group B Streptococcus or GBS) is the most common route for the GBS disease in the perinatal period. The knowledge of maternal colonization, antibiotic resistance and serotype profiles is substantially needed to formulate the broad vaccine. However, it has not been estimated in Africa. This meta-analysis was aimed to determine the pooled prevalence of colonization, antibiotic resistance and serotype profiles of GBS reported in Africa. Methods Potentially relevant studies from 1989 to 31th January, 2019 were retrieved from the Medline/PubMed, EMBASE, HINARI online databases, periodicals and by requesting authors. Unpublished studies retrieved from grey literature through Google and Google Scholar. Pooled estimates were calculated using the random effect model. Subgroup analysis was done to investigate the burden of colonization across sub-regions, sampling site and countries. Summary estimates were presented using words, Forest plots and Tables. Heterogeneity was assessed using the I2 statistic. Results Eighty-three articles were assessed, of which 57 studies conducted in five sub-regions with 21 countries (22,206 pregnant women) met pre-specified inclusion criteria. The overall estimate of recto-vaginal colonization was 19.3% (95% CI 16.9, 21.7). The highest estimate was observed in Southern Africa, 23.8% (95% CI 18.7, 28.9), followed by Northern Africa, 22.7% (95% CI 18.2, 27.2) while the lowest was driven from the Eastern Africa, 15.4% (95% CI 12.1, 18.7). Considerable heterogeneity across and within regions, sampling site, screening methods and countries (I2 > 75%); and the publication bias were observed (p = 0.031). GBS showed the highest resistance to tetracycline. Resistance to penicillin, amoxicillin, chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, erythromycin, vancomycin and clindamycin also observed. The V, III, Ia, Ib, and II serotypes altogether were accounted 91.8% in the African studies. Conclusions The pooled estimate of the maternal colonization with GBS was 19.3% which is equivalent with other many primary and review reports worldwide. The most antibiotic resistance estimate was recorded in the tetracycline followed by penicillin. Five serotypes were the most prevalent in Africa and more data on the antibiotic résistance and serotype distribution patterns are needed from developing countries to devise the effective preventive measures. In addition, the antibiotic susceptibility test methods used in the Africa shall be assessed for its quality. Trial registration Prospero Registration Number CRD42018094525
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Affiliation(s)
- Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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269
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Rothen J, Pothier JF, Foucault F, Blom J, Nanayakkara D, Li C, Ip M, Tanner M, Vogel G, Pflüger V, Daubenberger CA. Subspecies Typing of Streptococcus agalactiae Based on Ribosomal Subunit Protein Mass Variation by MALDI-TOF MS. Front Microbiol 2019; 10:471. [PMID: 30915057 PMCID: PMC6421976 DOI: 10.3389/fmicb.2019.00471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background: A ribosomal subunit protein (rsp)-based matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) method was developed for fast subspecies-level typing of Streptococcus agalactiae (Group B Streptococcus, GBS), a major cause of neonatal sepsis and meningitis. Methods: A total of 796 GBS whole genome sequences, covering the genetic diversity of the global GBS population, were used to in silico predict molecular mass variability of 28 rsp and to identify unique rsp mass combinations, termed “rsp-profiles”. The in silico established GBS typing scheme was validated by MALDI-TOF MS analysis of GBS isolates at two independent research sites in Europe and South East Asia. Results: We identified in silico 62 rsp-profiles, with the majority (>80%) of the 796 GBS isolates displaying one of the six rsp-profiles 1–6. These dominant rsp-profiles classify GBS strains in high concordance with the core-genome based phylogenetic clustering. Validation of our approach by in-house MALDI-TOF MS analysis of 248 GBS isolates and external analysis of 8 GBS isolates showed that across different laboratories and MALDI-TOF MS platforms, the 28 rsp were detected reliably in the mass spectra, allowing assignment of clinical isolates to rsp-profiles at high sensitivity (99%) and specificity (97%). Our approach distinguishes the major phylogenetic GBS genotypes, identifies hyper-virulent strains, predicts the probable capsular serotype and surface protein variants and distinguishes between GBS genotypes of human and animal origin. Conclusion: We combine the information depth of whole genome sequences with the highly cost efficient, rapid and robust MALDI-TOF MS approach facilitating high-throughput, inter-laboratory, large-scale GBS epidemiological and clinical studies based on pre-defined rsp-profiles.
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Affiliation(s)
- Julian Rothen
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute (Swiss TPH) Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Joël F Pothier
- Research Group for Environmental Genomics and Systems Biology, Institute of Natural Resource Sciences, Zurich University of Applied Sciences (ZHAW), Wädenswil, Switzerland
| | | | - Jochen Blom
- Bioinformatics and Systems Biology, Justus-Liebig-Universität Gießen, Giessen, Germany
| | - Dulmini Nanayakkara
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Li
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | | | | | - Claudia A Daubenberger
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute (Swiss TPH) Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
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270
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Sutton JA, Rogers LM, Dixon B, Kirk L, Doster R, Algood HM, Gaddy JA, Flaherty R, Manning SD, Aronoff DM. Protein kinase D mediates inflammatory responses of human placental macrophages to Group B Streptococcus. Am J Reprod Immunol 2019; 81:e13075. [PMID: 30582878 PMCID: PMC6459189 DOI: 10.1111/aji.13075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 01/22/2023] Open
Abstract
PROBLEM During pregnancy, Group B Streptococcus (GBS) can infect fetal membranes to cause chorioamnionitis, resulting in adverse pregnancy outcomes. Macrophages are the primary resident phagocyte in extraplacental membranes. Protein kinase D (PKD) was recently implicated in mediating pro-inflammatory macrophage responses to GBS outside of the reproductive system. This work aimed to characterize the human placental macrophage inflammatory response to GBS and address the extent to which PKD mediates such effects. METHOD Primary human placental macrophages were infected with GBS in the presence or absence of a specific, small molecule PKD inhibitor, CRT 0066101. Macrophage phenotypes were characterized by evaluating gene expression, cytokine release, assembly of the NLRP3 inflammasome, and NFκB activation. RESULTS GBS evoked a strong inflammatory phenotype characterized by the release of inflammatory cytokines (TNFα, IL-1β, IL-6 (P ≤ 0.05), NLRP3 inflammasome assembly (P ≤ 0.0005), and NFκB activation (P ≤ 0.05). Pharmacological inhibition of PKD suppressed these responses, newly implicating a role for PKD in mediating immune responses of primary human placental macrophages to GBS. CONCLUSION PKD plays a critical role in mediating placental macrophage inflammatory activation in response to GBS infection.
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Affiliation(s)
- Jessica A. Sutton
- Department of Microbiology and Immunology, Meharry Medical College School of Medicine, Nashville, TN, 37208, USA
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lisa M. Rogers
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Beverly Dixon
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Leslie Kirk
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ryan Doster
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Holly M. Algood
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee, U.S.A
| | - Jennifer A. Gaddy
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee, U.S.A
| | - Rebecca Flaherty
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, USA
| | - Shannon D. Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan, USA
| | - David M. Aronoff
- Department of Microbiology and Immunology, Meharry Medical College School of Medicine, Nashville, TN, 37208, USA
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
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271
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Seedat F, Geppert J, Stinton C, Patterson J, Freeman K, Johnson SA, Fraser H, Brown CS, Uthman OA, Tan B, Robinson ER, McCarthy ND, Clarke A, Marshall J, Visintin C, Mackie A, Taylor-Phillips S. Universal antenatal screening for group B streptococcus may cause more harm than good. BMJ 2019; 364:l463. [PMID: 30787018 DOI: 10.1136/bmj.l463] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Farah Seedat
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Julia Geppert
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Chris Stinton
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Jacoby Patterson
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Karoline Freeman
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Samantha Ann Johnson
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Hannah Fraser
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Colin Stewart Brown
- Bacteria Reference Department, National Infection Service, Public Health England, London, UK
| | - Olalekan A Uthman
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Bee Tan
- Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
| | - Esther R Robinson
- Field Service, National Infection Service, Public Health England, Nottingham, UK
| | - Noel Denis McCarthy
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | | | | | | | - Sian Taylor-Phillips
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
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272
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Tsai MH, Hsu JF, Lai MY, Lin LC, Chu SM, Huang HR, Chiang MC, Fu RH, Lu JJ. Molecular Characteristics and Antimicrobial Resistance of Group B Streptococcus Strains Causing Invasive Disease in Neonates and Adults. Front Microbiol 2019; 10:264. [PMID: 30833941 PMCID: PMC6387999 DOI: 10.3389/fmicb.2019.00264] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 02/01/2019] [Indexed: 11/17/2022] Open
Abstract
We aimed to analyze the molecular characteristics, clonality and antimicrobial resistance profiles of group B streptococcus (GBS) isolates collected in Taiwan from invasive diseases and carriage. Multilocus sequence typing (MLST) was used to assess the genetic diversity of 225 GBS strains from neonates and adults with invasive GBS diseases. 100 GBS strains collected from colonized pregnant women during the same period were compared, and all strains were characterized for one of nine capsule genotypes. We also determined the susceptibilities of all GBS isolates to various antimicrobial agents. The most frequently identified serotypes that caused invasive disease in neonates were III (60.6%) and Ia (17.3%), whereas type VI (32.7%), Ib (19.4%), and V (19.4%) were the most common to cause invasive disease in adults. Serotype VI was the leading type that colonized pregnant women (35.0%). Twenty-six sequence types (STs) were identified, and 90.5% of GBS strains were represented by 6 STs. ST-17 and ST-1 were more prevalent in invasive diseases in neonates and adults, respectively. The majority of serotype III and VI isolates belonged to clonal complex (CC)-17 and CC-1, respectively. ST-17 strains were more likely to cause meningitis and late-onset disease than other strains. In addition, ST-12 and ST-17 GBS strains showed the highest rate of resistance to erythromycin and clindamycin (range: 75.8–100%). In conclusion, CC-17/type III and CC-1/type VI are the most important invasive pathogens in infants and non-pregnant adults in Taiwan, respectively. GBS genotypes vary between different age groups and geographical areas and should be considered during GBS vaccine development.
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Affiliation(s)
- Ming-Horng Tsai
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Yin Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lee-Chung Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ren-Huei Fu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jang-Jih Lu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
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273
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Evaluation of matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) for the Identification of Group B Streptococcus. BMC Res Notes 2019; 12:85. [PMID: 30764872 PMCID: PMC6376729 DOI: 10.1186/s13104-019-4119-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/06/2019] [Indexed: 01/14/2023] Open
Abstract
Objective Group B Streptococcus (GBS) is a leading cause of neonatal meningitis and sepsis worldwide. Intrapartum antibiotics given to women carrying GBS are an effective means of reducing disease in the first week of life. Rapid and reliable tests are needed to accurately identify GBS from these women for timely intrapartum antibiotic administration to prevent neonatal disease. Many laboratories now use matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) by direct plating or cell lysis for the identification of GBS isolates. The cell lysis step increases time to results for clinical samples and is more complex to perform. Therefore, we seek to evaluate the sensitivity and specificity of the quicker and more rapid direct plating method in identifying GBS. Results We directly compared swab isolates analysed by both direct plating and cell lysis method and demonstrated that direct plating has a sensitivity and specificity of 0.97 and 1, respectively, compared to an additional cell lysis step. We demonstrated that MALDI-TOF MS can be successfully used for batch processing by the direct plating method which saves time. These results are reassuring for laboratories worldwide who seek to identify GBS from swabs samples as quickly as possible.
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274
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Armistead B, Oler E, Adams Waldorf K, Rajagopal L. The Double Life of Group B Streptococcus: Asymptomatic Colonizer and Potent Pathogen. J Mol Biol 2019; 431:2914-2931. [PMID: 30711542 DOI: 10.1016/j.jmb.2019.01.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
Group B streptococcus (GBS) is a β-hemolytic gram-positive bacterium that colonizes the lower genital tract of approximately 18% of women globally as an asymptomatic member of the gastrointestinal and/or vaginal flora. If established in other host niches, however, GBS is highly pathogenic. During pregnancy, ascending GBS infection from the vagina to the intrauterine space is associated with preterm birth, stillbirth, and fetal injury. In addition, vertical transmission of GBS during or after birth results in life-threatening neonatal infections, including pneumonia, sepsis, and meningitis. Although the mechanisms by which GBS traffics from the lower genital tract to vulnerable host niches are not well understood, recent advances have revealed that many of the same bacterial factors that promote asymptomatic vaginal carriage also facilitate dissemination and virulence. Furthermore, highly pathogenic GBS strains have acquired unique factors that enhance survival in invasive niches. Several host factors also exist that either subdue GBS upon vaginal colonization or alternatively permit invasive infection. This review summarizes the GBS and host factors involved in GBS's state as both an asymptomatic colonizer and an invasive pathogen. Gaining a better understanding of these mechanisms is key to overcoming the challenges associated with vaccine development and identification of novel strategies to mitigate GBS virulence.
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Affiliation(s)
- Blair Armistead
- Department of Global Health, University of Washington, Seattle 98195, WA, USA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle 98101, WA, USA
| | - Elizabeth Oler
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle 98195, WA, USA
| | - Kristina Adams Waldorf
- Department of Global Health, University of Washington, Seattle 98195, WA, USA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle 98195, WA, USA; Center for Innate Immunity and Immune Disease, University of Washington, Seattle 98109, WA, USA; Sahlgrenska Academy, Gothenburg University, Gothenburg 413 90, Sweden
| | - Lakshmi Rajagopal
- Department of Global Health, University of Washington, Seattle 98195, WA, USA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle 98101, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle 98195, WA, USA.
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275
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Yang Y, Luo M, Zhou H, Li C, Luk A, Zhao G, Fung K, Ip M. Role of Two-Component System Response Regulator bceR in the Antimicrobial Resistance, Virulence, Biofilm Formation, and Stress Response of Group B Streptococcus. Front Microbiol 2019; 10:10. [PMID: 30728810 PMCID: PMC6351488 DOI: 10.3389/fmicb.2019.00010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/07/2019] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS; Streptococcus agalactiae) is a leading cause of sepsis in neonates and pregnant mothers worldwide. Whereas the hyper-virulent serogroup III clonal cluster 17 has been associated with neonatal disease and meningitis, serogroup III ST283 was recently implicated in invasive disease among non-pregnant adults in Asia. Here, through comparative genome analyses of invasive and non-invasive ST283 strains, we identified a truncated DNA-binding regulator of a two-component system in a non-invasive strain that was homologous to Bacillus subtilis bceR, encoding the bceRSAB response regulator, which was conserved among GBS strains. Using isogenic knockout and complementation mutants of the ST283 strain, we demonstrated that resistance to bacitracin and the human antimicrobial peptide cathelicidin LL-37 was reduced in the ΔbceR strain with MICs changing from 64 and 256 μg/ml to 0.25 and 64 μg/ml, respectively. Further, the ATP-binding cassette transporter was upregulated by sub-inhibitory concentrations of bacitracin in the wild-type strain. Upregulation of dltA in the wild-type strain was also observed and thought to explain the increased resistance to antimicrobial peptides. DltA, an enzyme involved in D-alanylation during the synthesis of wall teichoic acids, which mediates reduced antimicrobial susceptibility, was previously shown to be regulated by the bceR-type regulator in Staphylococcus aureus. In a murine infection model, we found that the ΔbceR mutation significantly reduced the mortality rate compared to that with the wild-type strain (p < 0.01). Moreover, this mutant was more susceptible to oxidative stress compared to the wild-type strain (p < 0.001) and was associated with reduced biofilm formation (p < 0.0001). Based on 2-DGE and mass spectrometry, we showed that downregulation of alkyl hydroperoxide reductase (AhpC), a Gls24 family stress protein, and alcohol dehydrogenase (Adh) in the ΔbceR strain might explain the attenuated virulence and compromised stress response. Together, we showed for the first time that the bceR regulator in GBS plays an important role in bacitracin and antimicrobial peptide resistance, virulence, survival under oxidative stress, and biofilm formation.
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Affiliation(s)
- Ying Yang
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mingjing Luo
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Haokui Zhou
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Li
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alison Luk
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - GuoPing Zhao
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kitty Fung
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
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276
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Gizachew M, Tiruneh M, Moges F, Adefris M, Tigabu Z, Tessema B. Streptococcus agalactiae from Ethiopian pregnant women; prevalence, associated factors and antimicrobial resistance: alarming for prophylaxis. Ann Clin Microbiol Antimicrob 2019; 18:3. [PMID: 30660188 PMCID: PMC6339690 DOI: 10.1186/s12941-019-0303-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/10/2019] [Indexed: 01/31/2023] Open
Abstract
Background Maternal Streptococcus agalactiae (Group B Streptococcus, GBS) colonization rates and its antibiotic resistance patterns provide important information useful in guiding prevention strategies. There is a paucity of evidence about GBS in the Amhara National Regional State, Ethiopia. Objective To determine colonization prevalence, associated risk factors, and antibiotics resistance including inducible clindamycin resistance patterns of GBS among Ethiopian pregnant women. Methods A prospective cross-sectional study was conducted from 1st December 2016 to 30th November 2017 at the University of Gondar Referral hospital delivery ward. Combined recto-vaginal swabs were collected from 385 pregnant women and analyzed at the University of Gondar Bacteriology Laboratory by using LIM broth and 5% defibrinated sheep blood agar culture methods. Isolates were identified by using colony morphology, gram reaction, hemolysis, and CAMP test. Antibiotic susceptibility test was done using the disc diffusion method. Double disc diffusion method was used to identify inducible clindamycin resistance isolates. Data were analyzed by SPSS version 20 software. p ≤ 0.05 was considered as statistically significant. Results The overall prevalence of maternal GBS colonization was 25.5% (95% CI 21–29.5%). Experiencing meconium stained amniotic fluid (AOR = 3.018, 95% CI 1.225, 7.437), and longer duration of premature rupture of membrane (AOR = 1.897, 95% CI 1.014, 3.417) were statistically significant to maternal colonization. Furthermore, GBS resistant to 0 (8.2%), 1 (25.5%) and 3 (39.8%) or more antibiotics were identified. A D-test showed 15.2% inducible clindamycin resistant GBS. Constitutive macrolide lincosamide–streptograminB, L-, and M-phenotypes were also detected. Conclusions Maternal GBS colonization rate in this study was higher compared to the previous reports in Ethiopia. This much prevalence and antibiotics resistance results are the clue to which attention shall be given to this bacterium during management of pregnant women and the newborns.
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Affiliation(s)
- Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Mulat Adefris
- Department of Gynecology and Obstetrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Zemene Tigabu
- Department of Pediatrics, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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277
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Causal role of group B Streptococcus-induced acute chorioamnionitis in intrauterine growth retardation and cerebral palsy-like impairments. J Dev Orig Health Dis 2019; 10:595-602. [PMID: 30626456 DOI: 10.1017/s2040174418001083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chorioamnionitis and intrauterine growth retardation (IUGR) are risk factors for cerebral palsy (CP). Common bacteria isolated in chorioamnionitis include group B Streptococcus (GBS) serotypes Ia and III. Little is known about the impact of placental inflammation induced by different bacteria, including different GBS strains. We aimed to test the impact of chorioamnionitis induced by two common GBS serotypes (GBSIa and GBSIII) on growth and neuromotor outcomes in the progeny. Dams were exposed at the end of gestation to either saline, inactivated GBSIa or GBSIII. Inactivated GBS bacteria invaded placentas and triggered a chorioamnionitis featured by massive polymorphonuclear cell infiltrations. Offspring exposed to GBSIII - but not to GBSIa - developed IUGR, persisting beyond adolescent age. Male rats in utero exposed to GBSIII traveled a lower distance in the Open Field test, which was correlating with their level of IUGR. GBSIII-exposed rats presented decreased startle responses to acoustic stimuli beyond adolescent age. GBS-exposed rats displayed a dysmyelinated white matter in the corpus callosum adjacent to thinner primary motor cortices. A decreased density of microglial cells was detected in the mature corpus callosum of GBSIII-exposed males - but not females - which was correlating positively with the primary motor cortex thickness. Altogether, our results demonstrate a causal link between pathogen-induced acute chorioamnionitis and (1) IUGR, (2) serotype- and sex-specific neuromotor impairments and (3) abnormal development of primary motor cortices, dysmyelinated white matter and decreased density of microglial cells.
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278
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Bengtson AM, Sanfilippo AM, Hughes BL, Savitz DA. Maternal immunisation to improve the health of HIV-exposed infants. THE LANCET. INFECTIOUS DISEASES 2018; 19:e120-e131. [PMID: 30529212 DOI: 10.1016/s1473-3099(18)30545-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/28/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
HIV-exposed but uninfected (HEU) infants are at an increased risk of many infectious diseases that can contribute to the high mortality seen among HEU children. Maternal immunisation could be a promising strategy to reduce infections in HEU infants. However, very little research has explored the effect of HIV on the immunogenicity and effectiveness of vaccines given during pregnancy. We review the available evidence on maternal immunisation among women living with HIV (WLWH) for all vaccines recommended, considered, or being investigated for routine or risk-based use during pregnancy. Of the 11 vaccines included, only three have been investigated in WLWH. Available evidence suggests that maternal HIV infection limits the immunogenicity of several vaccines, leaving HEU infants more susceptible to infection during their first few months of life. Whether maternal immunisation reduces the infectious morbidity and mortality associated with infectious diseases in HEU children remains unknown. We conclude the Review by identifying future research priorities.
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Affiliation(s)
- Angela M Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Alan M Sanfilippo
- Department of Pathology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Brenna L Hughes
- Division of Maternal Fetal Medicine, Duke University, Durham, NC, USA
| | - David A Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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279
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Africa CWJ, Kaambo E. Group B Streptococcus Serotypes in Pregnant Women From the Western Cape Region of South Africa. Front Public Health 2018; 6:356. [PMID: 30564566 PMCID: PMC6288474 DOI: 10.3389/fpubh.2018.00356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Maternal colonization of Group B streptococci (GBS) during pregnancy is an important risk factor for neonatal morbidity and mortality. The aim of this study was to determine the prevalence and serotype distribution of GBS isolated from a cohort of pregnant women in the Western Cape, South Africa. Methods: Two ano-vaginal swabs were collected from 301 women at 28-37 weeks of gestation. Participants were recruited from four different antenatal clinics in the Western Cape, South Africa. GBS were detected by culture and PCR and serotypes confirmed by latex agglutination tests. Antibiotic sensitivity was performed using disc diffusion. Results: The GBS colonization rate was 16.6%. Serotype distribution revealed serotype V as the predominant serotype (66.67%) followed by serotype III (21.05%). Serotypes Ia, II, IV, and IX constituted 1.75% each and 3 GBS isolates were non-typeable. Serotype V demonstrated resistance to most of the antibiotics tested, while serotype III demonstrated better susceptibility, except for tetracycline. No significant differences were observed for GBS colonization or serotype distribution according to HIV status. Conclusion: Predominating serotypes differed from those previously reported from other regions in South Africa. Global surveillance of serotype distribution plays an important role in informing vaccine development and antibiotic prophylaxis.
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Affiliation(s)
- Charlene W. J. Africa
- Maternal Endogenous Infections Studies (MEnIS) Research Laboratories, Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
| | - Eveline Kaambo
- Maternal Endogenous Infections Studies (MEnIS) Research Laboratories, Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
- Department of Biochemistry and Microbiology, University of Namibia Medical School, Windhoek, Namibia
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280
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Dauby N, Adler C, Miendje Deyi VY, Sacheli R, Busson L, Chamekh M, Marchant A, Barlow P, De Wit S, Levy J, Melin P, Goetghebuer T. Prevalence, Risk Factors, and Serotype Distribution of Group B Streptococcus Colonization in HIV-Infected Pregnant Women Living in Belgium: A Prospective Cohort Study. Open Forum Infect Dis 2018; 5:ofy320. [PMID: 30619909 PMCID: PMC6306564 DOI: 10.1093/ofid/ofy320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background Group B streptococcus (GBS) infection is a leading cause of severe neonatal infection. Maternal GBS carriage during pregnancy is the main risk factor for both early-onset and late-onset GBS disease. High incidence of GBS infection has been reported in HIV-exposed but -uninfected infants (HEU). We aimed to determine the prevalence, characteristics, and risk factors for GBS colonization in HIV-infected and HIV-uninfected pregnant women living in Belgium. Methods Between January 1, 2011, and December 31, 2013, HIV-infected (n = 125) and -uninfected (n = 120) pregnant women had recto-vaginal swabs at 35–37 weeks of gestation and at delivery for GBS detection. Demographic, obstetrical, and HIV infection–related data were prospectively collected. GBS capsular serotyping was performed on a limited number of samples (33 from HIV-infected and 16 from HIV-uninfected pregnant women). Results There was no significant difference in the GBS colonization rate between HIV-infected and -uninfected pregnant women (29.6% vs 24.2%, respectively). HIV-infected women were more frequently colonized by serotype III (36.4% vs 12.5%), and the majority of serotype III strains belonged to the hypervirulent clone ST-17. Exclusively trivalent vaccine serotypes (Ia, Ib, and III) were found in 57.6% and 75% of HIV-infected and -uninfected women, respectively, whereas the hexavalent vaccine serotypes (Ia, Ib, II, III, IV, and V) were found in 97% and 100%, respectively. Conclusions HIV-infected and -uninfected pregnant women living in Belgium have a similar GBS colonization rate. A trend to a higher colonization rate with serotype III was found in HIV-infected women, and those serotype III strains belong predominantly to the hypervirulent clone ST17.
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Affiliation(s)
- Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Catherine Adler
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Veronique Y Miendje Deyi
- Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB) Microbiology Department, Pôle Hospitalier Universitaire de Bruxelles, Brussels, Belgium
| | - Rosalie Sacheli
- Department of Clinical Microbiology, National Reference Center for Group B Streptococcus, Centre Hospitalier Universitaire Sart-Tilman, Université de Liège, Liège, Belgium
| | - Laurent Busson
- Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB) Microbiology Department, Pôle Hospitalier Universitaire de Bruxelles, Brussels, Belgium
| | - Mustapha Chamekh
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Arnaud Marchant
- Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Gosselies, Belgium
| | - Patricia Barlow
- Department of Obstetrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jack Levy
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierrette Melin
- Department of Clinical Microbiology, National Reference Center for Group B Streptococcus, Centre Hospitalier Universitaire Sart-Tilman, Université de Liège, Liège, Belgium
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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281
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Streptococcus agalactiae Induces Placental Macrophages To Release Extracellular Traps Loaded with Tissue Remodeling Enzymes via an Oxidative Burst-Dependent Mechanism. mBio 2018; 9:mBio.02084-18. [PMID: 30459195 PMCID: PMC6247082 DOI: 10.1128/mbio.02084-18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Streptococcus agalactiae, also known as group B Streptococcus (GBS), is a common pathogen during pregnancy where infection can result in chorioamnionitis, preterm premature rupture of membranes (PPROM), preterm labor, stillbirth, and neonatal sepsis. Mechanisms by which GBS infection results in adverse pregnancy outcomes are still incompletely understood. This study evaluated interactions between GBS and placental macrophages. The data demonstrate that in response to infection, placental macrophages release extracellular traps capable of killing GBS. Additionally, this work establishes that proteins associated with extracellular trap fibers include several matrix metalloproteinases that have been associated with chorioamnionitis. In the context of pregnancy, placental macrophage responses to bacterial infection might have beneficial and adverse consequences, including protective effects against bacterial invasion, but they may also release important mediators of membrane breakdown that could contribute to membrane rupture or preterm labor. Streptococcus agalactiae, or group B Streptococcus (GBS), is a common perinatal pathogen. GBS colonization of the vaginal mucosa during pregnancy is a risk factor for invasive infection of the fetal membranes (chorioamnionitis) and its consequences such as membrane rupture, preterm labor, stillbirth, and neonatal sepsis. Placental macrophages, or Hofbauer cells, are fetally derived macrophages present within placental and fetal membrane tissues that perform vital functions for fetal and placental development, including supporting angiogenesis, tissue remodeling, and regulation of maternal-fetal tolerance. Although placental macrophages as tissue-resident innate phagocytes are likely to engage invasive bacteria such as GBS, there is limited information regarding how these cells respond to bacterial infection. Here, we demonstrate in vitro that placental macrophages release macrophage extracellular traps (METs) in response to bacterial infection. Placental macrophage METs contain proteins, including histones, myeloperoxidase, and neutrophil elastase similar to neutrophil extracellular traps, and are capable of killing GBS cells. MET release from these cells occurs by a process that depends on the production of reactive oxygen species. Placental macrophage METs also contain matrix metalloproteases that are released in response to GBS and could contribute to fetal membrane weakening during infection. MET structures were identified within human fetal membrane tissues infected ex vivo, suggesting that placental macrophages release METs in response to bacterial infection during chorioamnionitis.
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282
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Abstract
Group B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in many countries and responsible for significant perinatal morbidity and mortality worldwide. Intrapartum antibiotic prophylaxis has been the mainstay of efforts to prevent early-onset GBS disease in recent decades, however it is unclear if women should be targeted based on the presence of clinical risk factors or by screening for GBS colonisation during pregnancy. Universal bacteriological screening of women in late pregnancy has been widely adopted but questions remain regarding its benefits and potential harms. Newer approaches to screening based on rapid point-of-care testing require further evaluation in randomised controlled trials to inform evidence-based practice. Given current preventive strategies do not protect against late onset disease and other sequelae of infection, maternal vaccination against GBS may present the best opportunity to reduce the global burden of invasive GBS disease in the future.
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283
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De Gaetano GV, Pietrocola G, Romeo L, Galbo R, Lentini G, Giardina M, Biondo C, Midiri A, Mancuso G, Venza M, Venza I, Firon A, Trieu-Cuot P, Teti G, Speziale P, Beninati C. The Streptococcus agalactiae cell wall-anchored protein PbsP mediates adhesion to and invasion of epithelial cells by exploiting the host vitronectin/α v integrin axis. Mol Microbiol 2018; 110:82-94. [PMID: 30030946 DOI: 10.1111/mmi.14084] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 01/02/2023]
Abstract
Binding of microbial pathogens to host vitronectin (Vtn) is a common theme in the pathogenesis of invasive infections. In this study, we characterized the role of Vtn in the invasion of mucosal epithelial cells by Streptococcus agalactiae (i.e. group B streptococcus or GBS), a frequent human pathogen. Moreover, we identified PbsP, a previously described plasminogen-binding protein of GBS, as a dual adhesin that can also interact with human Vtn through its streptococcal surface repeat (SSURE) domains. Deletion of the pbsP gene decreases both bacterial adhesion to Vtn-coated inert surfaces and the ability of GBS to interact with epithelial cells. Bacterial adherence to and invasion of epithelial cells were either inhibited or enhanced by cell pretreatment with, respectively, anti-Vtn antibodies or Vtn, confirming the role of Vtn as a GBS ligand on host cells. Finally, antibodies directed against the integrin αv subunit inhibited Vtn-dependent cell invasion by GBS. Collectively, these results indicate that Vtn acts as a bridge between the SSURE domains of PbsP on the GBS surface and host integrins to promote bacterial invasion of epithelial cells. Therefore, inhibition of interactions between PbsP and extracellular matrix components could represent a viable strategy to prevent colonization and invasive disease by GBS.
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Affiliation(s)
- Giuseppe Valerio De Gaetano
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Giampiero Pietrocola
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | - Letizia Romeo
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Roberta Galbo
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Germana Lentini
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Miriam Giardina
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Carmelo Biondo
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Angelina Midiri
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Giuseppe Mancuso
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Mario Venza
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Isabella Venza
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Arnaud Firon
- Institut Pasteur, Unite de Biologie des Bacteriés Pathogènes a Gram positif, CNRS ERL6002, 75015, Paris, France
| | - Patrick Trieu-Cuot
- Institut Pasteur, Unite de Biologie des Bacteriés Pathogènes a Gram positif, CNRS ERL6002, 75015, Paris, France
| | - Giuseppe Teti
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy
| | - Pietro Speziale
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy.,Department of Industrial and Information Engineering, University of Pavia, Pavia, Italy
| | - Concetta Beninati
- Metchnikoff Laboratory, Departments of Human Pathology, Medicine, Biomedical Sciences and Chemical Sciences, University of Messina, Messina, Italy.,Scylla Biotech Srl, Messina, Italy
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284
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Jauneikaite E, Kapatai G, Davies F, Gozar I, Coelho J, Bamford KB, Simone B, Begum L, Katiyo S, Patel B, Hoffman P, Lamagni T, Brannigan ET, Holmes AH, Kadhani T, Galletly T, Martin K, Lyall H, Chow Y, Godambe S, Chalker V, Sriskandan S. Serial Clustering of Late-Onset Group B Streptococcal Infections in the Neonatal Unit: A Genomic Re-evaluation of Causality. Clin Infect Dis 2018; 67:854-860. [PMID: 29509833 PMCID: PMC6117446 DOI: 10.1093/cid/ciy174] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background Invasive Group B streptococcus (GBS) is a major cause of serious neonatal infection. Current strategies to reduce early-onset GBS disease have no impact on late-onset disease (LOD). Although GBS LOD is viewed as a sporadic event in the community, LOD arising within the neonatal intensive care unit (ICU) raises questions about mode of acquisition. Methods Following a cluster of 4 GBS LOD cases, enhanced surveillance for all GBS LOD was undertaken over 2 years in the neonatal ICU supported by neonatal rectal screening. GBS isolates were serotyped and genome-sequenced. Results Twelve late -onset invasive GBS episodes were identified (incidence 0.6/1000 live births). Genomic analysis revealed that 11/12 GBS isolates (92%) were linked to at least one other LOD isolate. Isolates from the first cluster were serotype V, resistant to macrolides and lincosamides, and sequencing confirmed isolates were indistinguishable, or distinguishable by only one SNP difference, from each other. Rectal carriage was rare. Prospective surveillance identified three further clusters of LOD due to serotypes Ia (3 cases), Ib (2 cases), and III (2 cases), that would not have been identified without surveillance and genome sequencing, leading to a re-evaluation of interventions required to prevent GBS LOD. Conclusion Acquisition routes for LOD GBS in the neonatal ICU are poorly understood; cases may not necessarily be sporadic. Within this neonatal ICU, our data suggest that a single case of LOD GBS sepsis should be considered a potential nosocomial transmission event warranting prompt investigation, heightened infection prevention vigilance and action where required.
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Affiliation(s)
- Elita Jauneikaite
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, United Kingdom
| | - Georgia Kapatai
- National Infection Service, Public Health England, United Kingdom
| | | | - Ioana Gozar
- Imperial College Healthcare NHS Trust, United Kingdom
| | - Juliana Coelho
- National Infection Service, Public Health England, United Kingdom
| | | | - Benedetto Simone
- London and South East Field Epidemiology Services, United Kingdom
| | - Lipi Begum
- North West London Health Protection Team, Public Health England, United Kingdom
| | - Shannon Katiyo
- London and South East Field Epidemiology Services, United Kingdom
| | - Bharat Patel
- National Infection Service, Public Health England, United Kingdom
| | - Peter Hoffman
- National Infection Service, Public Health England, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, United Kingdom
| | | | - Alison H Holmes
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, United Kingdom
| | | | | | - Kate Martin
- Imperial College Healthcare NHS Trust, United Kingdom
| | | | - Yimmy Chow
- North West London Health Protection Team, Public Health England, United Kingdom
| | - Sunit Godambe
- Imperial College Healthcare NHS Trust, United Kingdom
| | - Victoria Chalker
- National Infection Service, Public Health England, United Kingdom
| | - Shiranee Sriskandan
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, United Kingdom
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285
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Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets. Clin Microbiol Rev 2018; 31:31/4/e00049-18. [PMID: 30111577 DOI: 10.1128/cmr.00049-18] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Streptococcus agalactiae, or group B streptococcus (GBS), is a major neonatal pathogen. Recent data have elucidated the global prevalence of maternal and neonatal colonization, but gaps still remain in the epidemiology of this species. A number of phenotypic and genotypic classifications can be used to identify the diversity of GBS strains, and some are more discriminatory than others. This review explores the main schemes used for GBS epidemiology and further details the targets for epidemiological surveillance. Current screening practices across the world provide a unique opportunity to gain detailed information on maternal colonizing strains and neonatal disease-causing strains, which is vital for monitoring and therapeutics, if sufficient detail can be extracted. Deciphering which isolates are circulating within specific populations and recording targets within invasive strains are crucial steps in monitoring the implementation of therapeutics, such as vaccines, as well as developing novel therapies against prevalent GBS strains. Having a detailed understanding of global GBS epidemiology will prove invaluable for understanding the pathogenesis of this organism and equipping future prevention strategies for success.
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286
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Russell NJ, Seale AC, O'Sullivan C, Le Doare K, Heath PT, Lawn JE, Bartlett L, Cutland C, Gravett M, Ip M, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-Ter Meulen A, Vekemans J, Baker CJ. Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2018; 65:S152-S159. [PMID: 29117325 PMCID: PMC5850448 DOI: 10.1093/cid/cix655] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Early-onset group B streptococcal disease (EOGBS) occurs in neonates (days 0-6) born to pregnant women who are rectovaginally colonized with group B Streptococcus (GBS), but the risk of EOGBS from vertical transmission has not been systematically reviewed. This article, the seventh in a series on the burden of GBS disease, aims to estimate this risk and how it varies with coverage of intrapartum antibiotic prophylaxis (IAP), used to reduce the incidence of EOGBS. Methods We conducted systematic reviews (Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on maternal GBS colonization and neonatal outcomes. We included articles with ≥200 GBS colonized pregnant women that reported IAP coverage. We did meta-analyses to determine pooled estimates of risk of EOGBS, and examined the association in risk of EOGBS with IAP coverage. Results We identified 30 articles including 20328 GBS-colonized pregnant women for inclusion. The risk of EOGBS in settings without an IAP policy was 1.1% (95% confidence interval [CI], .6%-1.5%). As IAP increased, the risk of EOGBS decreased, with a linear association. Based on linear regression, the risk of EOGBS in settings with 80% IAP coverage was predicted to be 0.3% (95% CI, 0-.9). Conclusions The risk of EOGBS among GBS-colonized pregnant women, from this first systematic review, is consistent with previous estimates from single studies (1%-2%). Increasing IAP coverage was linearly associated with decreased risk of EOGBS disease.
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Affiliation(s)
- Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,King's College London, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group, St George's, University of London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, St George's, University of London, United Kingdom.,Centre for International Child Health, Imperial College London, United Kingdom
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's, University of London, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Michael Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
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287
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Madrid L, Seale AC, Kohli-Lynch M, Edmond KM, Lawn JE, Heath PT, Madhi SA, Baker CJ, Bartlett L, Cutland C, Gravett MG, Ip M, Le Doare K, Rubens CE, Saha SK, Sobanjo-Ter Meulen A, Vekemans J, Schrag S. Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2018; 65:S160-S172. [PMID: 29117326 PMCID: PMC5850457 DOI: 10.1093/cid/cix656] [Citation(s) in RCA: 262] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates. Methods We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0–89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence. Results We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI], .43–.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI, .36–.47); late-onset disease incidence was 0.26 (95% CI, .21–.30). CFR was 8.4% (95% CI, 6.6%–10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V. Conclusions The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.
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Affiliation(s)
- Lola Madrid
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic-University of Barcelona, Spain.,Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,Centro de Investigação em Saúde de Manhiça, Mozambique
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences.,National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George's, University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom.,Centre for International Child Health, Imperial College London, United Kingdom
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Global Health, University of Washington, Seattle
| | | | | | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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288
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Seale AC, Blencowe H, Bianchi-Jassir F, Embleton N, Bassat Q, Ordi J, Menéndez C, Cutland C, Briner C, Berkley JA, Lawn JE, Baker CJ, Bartlett L, Gravett MG, Heath PT, Ip M, Le Doare K, Rubens CE, Saha SK, Schrag S, Meulen AST, Vekemans J, Madhi SA. Stillbirth With Group B Streptococcus Disease Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2018; 65:S125-S132. [PMID: 29117322 PMCID: PMC5850020 DOI: 10.1093/cid/cix585] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background There are an estimated 2.6 million stillbirths each year, many of which are due to infections, especially in low- and middle-income contexts. This paper, the eighth in a series on the burden of group B streptococcal (GBS) disease, aims to estimate the percentage of stillbirths associated with GBS disease. Methods We conducted systematic literature reviews (PubMed/Medline, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, World Health Organization Library Information System, and Scopus) and sought unpublished data from investigator groups. Studies were included if they reported original data on stillbirths (predominantly ≥28 weeks’ gestation or ≥1000 g, with GBS isolated from a sterile site) as a percentage of total stillbirths. We did meta-analyses to derive pooled estimates of the percentage of GBS-associated stillbirths, regionally and worldwide for recent datasets. Results We included 14 studies from any period, 5 with recent data (after 2000). There were no data from Asia. We estimated that 1% (95% confidence interval [CI], 0–2%) of all stillbirths in developed countries and 4% (95% CI, 2%–6%) in Africa were associated with GBS. Conclusions GBS is likely an important cause of stillbirth, especially in Africa. However, data are limited in terms of geographic spread, with no data from Asia, and cases worldwide are probably underestimated due to incomplete case ascertainment. More data, using standardized, systematic methods, are critical, particularly from low- and middle-income contexts where the highest burden of stillbirths occurs. These data are essential to inform interventions, such as maternal GBS vaccination.
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Affiliation(s)
- Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom.,College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institució Catalana de Recerca i Estudis Avançats.,ISGlobal, Barcelona Centre for International Health Research
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ISGlobal, Barcelona Centre for International Health Research.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Clare Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Carmen Briner
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Oxford University, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George's Hospital, University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George's Hospital, University of London and St George's University Hospitals NHS Foundation Trust, United Kingdom.,Centre for International Child Health, Imperial College London, United Kingdom
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington.,Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
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289
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Affiliation(s)
- Paul Loubet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Paris, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Olivia Anselem
- AP-HP, Maternité Port-Royal, Département de Gynécologie-Obstétrique, Hôpital Cochin Broca Hôtel-Dieu, Paris, France
- DHU Risk in pregnancy, Université Paris Descartes, Paris, France
| | - Odile Launay
- Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
- Inserm, CIC 1417, Université Paris Descartes, Paris, France
- AP-HP, Département de maladies infectieuses, CIC Cochin Pasteur, Paris, France
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290
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Moraleda C, Benmessaoud R, Esteban J, López Y, Alami H, Barkat A, Houssain T, Kabiri M, Bezad R, Chaacho S, Madrid L, Vila J, Muñoz-Almagro C, Bosch J, Soto SM, Bassat Q. Prevalence, antimicrobial resistance and serotype distribution of group B streptococcus isolated among pregnant women and newborns in Rabat, Morocco. J Med Microbiol 2018. [PMID: 29543148 DOI: 10.1099/jmm.0.000720] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose. Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage, antibiotic susceptibility and circulating serotypes are necessary to tailor adequate locally relevant public health policies.Methodology. A prospective study including pregnant women and their newborns was conducted between March and July 2013 in Morocco. We collected clinical data and vagino-rectal and urine samples from the recruited pregnant women, together with the clinical characteristics of, and body surface samples from, their newborns. Additionally, the first three newborns admitted every day with suspected invasive infection were recruited for a thorough screening for neonatal sepsis. Serotypes were characterized by molecular testing.Results. A total of 350 pregnant women and 139 of their newborns were recruited. The prevalence of pregnant women colonized by GBS was 24 %. In 5/160 additional sick newborns recruited with suspected sepsis, the blood cultures were positive for GBS. Gestational hypertension and vaginal pruritus were significantly associated with a vagino-rectal GBS colonization in univariate analyses. All of the strains were susceptible to penicillin, while 7 % were resistant to clindamycin and 12 % were resistant to erythromycin. The most common GBS serotypes detected included V, II and III.Conclusion. In Morocco, maternal GBS colonization is high. Penicillin can continue to be the cornerstone of intrapartum antibiotic prophylaxis. A pentavalent GBS vaccine (Ia, Ib, II, III and V) would have been effective against the majority of the colonizing cases in this setting, but a trivalent one (Ia, Ib and III) would only prevent 28 % of the cases.
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Affiliation(s)
- Cinta Moraleda
- Sección de Enfermedades Infecciosas de Pediatría, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Rachid Benmessaoud
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Laboratoire National de Reference, BD Mohamed Taieb Naciri, Hay el Hassani, Casablanca, Morocco
| | - Jessica Esteban
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Yuly López
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Hassan Alami
- Équipe de Recherche de Périnatologie, Université Mohammed V, Rabat, Morocco
| | - Amina Barkat
- Équipe de Recherche en Santé et Nutrition du Couple Mère Enfant, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Tligui Houssain
- Laboratoire de Recherche. Centre Hôpitalier Universitaire (CHU) Ibn Sina, Rabat, Morocco
| | - Meryem Kabiri
- Équipe de Recherche en Santé et Nutrition du Couple Mère Enfant, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Morocco
| | - Rachid Bezad
- Équipe de Recherche de Périnatologie, Université Mohammed V, Rabat, Morocco
| | - Saad Chaacho
- Centre Hôpitalier Universitaire (CHU) Ibn Sina, Rabat, Morocco
| | - Lola Madrid
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, University Hospital Sant Joan de Deu, Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
- Ciber de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Jordi Bosch
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Sara M Soto
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Pg Lluís Companys 23, 08010 Barcelona, Spain
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291
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Patras KA, Nizet V. Group B Streptococcal Maternal Colonization and Neonatal Disease: Molecular Mechanisms and Preventative Approaches. Front Pediatr 2018; 6:27. [PMID: 29520354 PMCID: PMC5827363 DOI: 10.3389/fped.2018.00027] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) colonizes the gastrointestinal and vaginal epithelium of a significant percentage of healthy women, with potential for ascending intrauterine infection or transmission during parturition, creating a risk of serious disease in the vulnerable newborn. This review highlights new insights on the bacterial virulence determinants, host immune responses, and microbiome interactions that underpin GBS vaginal colonization, the proximal step in newborn infectious disease pathogenesis. From the pathogen perspective, the function GBS adhesins and biofilms, β-hemolysin/cytolysin toxin, immune resistance factors, sialic acid mimicry, and two-component transcriptional regulatory systems are reviewed. From the host standpoint, pathogen recognition, cytokine responses, and the vaginal mucosal and placental immunity to the pathogen are detailed. Finally, the rationale, efficacy, and potential unintended consequences of current universal recommended intrapartum antibiotic prophylaxis are considered, with updates on new developments toward a GBS vaccine or alternative approaches to reducing vaginal colonization.
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Affiliation(s)
- Kathryn A Patras
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Victor Nizet
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
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292
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Seale AC, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ, Hall J, Madrid L, Blencowe H, Cousens S, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag SJ, Sobanjo-ter Meulen A, Vekemans J, Lawn JE. Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. Clin Infect Dis 2017; 65:S200-S219. [PMID: 29117332 PMCID: PMC5849940 DOI: 10.1093/cid/cix664] [Citation(s) in RCA: 289] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. METHODS For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. RESULTS Worldwide in 2015, we estimated 205000 (uncertainty range [UR], 101000-327000) infants with early-onset disease and 114000 (UR, 44000-326000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19000) presented with neonatal encephalopathy. There were 90000 (UR, 36000-169000) deaths in infants <3 months age, and, at least 10000 (UR, 3000-27000) children with disability each year. There were 33000 (UR, 13000-52000) cases of invasive GBS disease in pregnant or postpartum women, and 57000 (UR, 12000-104000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107000 (UR, 20000-198000) stillbirths and infant deaths. CONCLUSIONS Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409000 (UR, 144000-573000) maternal/fetal/infant cases and 147000 (UR, 47000-273000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.
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MESH Headings
- Brain Diseases/epidemiology
- Brain Diseases/etiology
- Brain Diseases/microbiology
- Cost of Illness
- Female
- Global Health/statistics & numerical data
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/microbiology
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/epidemiology
- Meningitis, Bacterial/microbiology
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/microbiology
- Stillbirth/epidemiology
- Streptococcal Infections/epidemiology
- Streptococcal Infections/microbiology
- Streptococcus agalactiae
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Affiliation(s)
- Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- King’s College London, United Kingdom
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Jenny Hall
- Department of Reproductive Health Research, University College London Institute for Women’s Health, United Kingdom
| | - Lola Madrid
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona, Spain
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Simon Cousens
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas;
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
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293
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Kohli-Lynch M, Russell NJ, Seale AC, Dangor Z, Tann CJ, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, O’Sullivan C, Nakwa F, Ben Hamouda H, Soua H, Giorgakoudi K, Ladhani S, Lamagni T, Rattue H, Trotter C, Lawn JE. Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017; 65:S190-S199. [PMID: 29117331 PMCID: PMC5848372 DOI: 10.1093/cid/cix663] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. RESULTS We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. CONCLUSIONS GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities.
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Affiliation(s)
- Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- King’s College London, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Ziyaad Dangor
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, and
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Catherine O’Sullivan
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | - Firdose Nakwa
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hechmi Ben Hamouda
- Department of Neonatology, University Hospital Tahar Sfar, Mahdia, Tunisia
| | - Habib Soua
- Department of Neonatology, University Hospital Tahar Sfar, Mahdia, Tunisia
| | | | | | | | - Hilary Rattue
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
| | | | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
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294
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Lawn JE, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ, Hall J, Madrid L, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Seale AC. Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children: Why, What, and How to Undertake Estimates? Clin Infect Dis 2017; 65:S89-S99. [PMID: 29117323 PMCID: PMC5850012 DOI: 10.1093/cid/cix653] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Improving maternal, newborn, and child health is central to Sustainable Development Goal targets for 2030, requiring acceleration especially to prevent 5.6 million deaths around the time of birth. Infections contribute to this burden, but etiological data are limited. Group B Streptococcus (GBS) is an important perinatal pathogen, although previously focus has been primarily on liveborn children, especially early-onset disease. In this first of an 11-article supplement, we discuss the following: (1) Why estimate the worldwide burden of GBS disease? (2) What outcomes of GBS in pregnancy should be included? (3) What data and epidemiological parameters are required? (4) What methods and models can be used to transparently estimate this burden of GBS? (5) What are the challenges with available data? and (6) How can estimates address data gaps to better inform GBS interventions including maternal immunization? We review all available GBS data worldwide, including maternal GBS colonization, risk of neonatal disease (with/without intrapartum antibiotic prophylaxis), maternal GBS disease, neonatal/infant GBS disease, and subsequent impairment, plus GBS-associated stillbirth, preterm birth, and neonatal encephalopathy. We summarize our methods for searches, meta-analyses, and modeling including a compartmental model. Our approach is consistent with the World Health Organization (WHO) Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), published in The Lancet and the Public Library of Science (PLoS). We aim to address priority epidemiological gaps highlighted by WHO to inform potential maternal vaccination.
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Affiliation(s)
- Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- King’s College London, United Kingdom
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Jennifer Hall
- Department of Reproductive Health Research, University College London Institute for Women’s Health, United Kingdom
| | - Lola Madrid
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic–University of Barcelona, Spain
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
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295
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Le Doare K, O’Driscoll M, Turner K, Seedat F, Russell NJ, Seale AC, Heath PT, Lawn JE, Baker CJ, Bartlett L, Cutland C, Gravett MG, Ip M, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Kampmann B. Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review. Clin Infect Dis 2017; 65:S143-S151. [PMID: 29117324 PMCID: PMC5850619 DOI: 10.1093/cid/cix654] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide. METHODS We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated). RESULTS We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar. CONCLUSIONS There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease.
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Affiliation(s)
- Kirsty Le Doare
- Centre for International Child Health, Imperial College London, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Megan O’Driscoll
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Kim Turner
- Global Medicine, University of Southern California, Los Angeles
| | - Farah Seedat
- University of Warwick Medical School, Gibbet Hill, Coventry
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- King’s College London, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Beate Kampmann
- Centre for International Child Health, Imperial College London, United Kingdom
- Medical Research Council Unit, Fajara, The Gambia
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296
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Hall J, Adams NH, Bartlett L, Seale AC, Lamagni T, Bianchi-Jassir F, Lawn JE, Baker CJ, Cutland C, Heath PT, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Gravett MG. Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017; 65:S112-S124. [PMID: 29117328 PMCID: PMC5850000 DOI: 10.1093/cid/cix660] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infections such as group B Streptococcus (GBS) are an important cause of maternal sepsis, yet limited data on epidemiology exist. This article, the third of 11, estimates the incidence of maternal GBS disease worldwide. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on invasive GBS disease in women pregnant or within 42 days postpartum. We undertook meta-analyses to derive pooled estimates of the incidence of maternal GBS disease. We examined maternal and perinatal outcomes and GBS serotypes. RESULTS Fifteen studies and 1 unpublished dataset were identified, all from United Nations-defined developed regions. From a single study with pregnancies as the denominator, the incidence of maternal GBS disease was 0.38 (95% confidence interval [CI], .28-.48) per 1000 pregnancies. From 3 studies reporting cases by the number of maternities (pregnancies resulting in live/still birth), the incidence was 0.23 (95% CI, .09-.37). Five studies reported serotypes, with Ia being the most common (31%). Most maternal GBS disease was detected at or after delivery. CONCLUSIONS Incidence data on maternal GBS disease in developing regions are lacking. In developed regions the incidence is low, as are the sequelae for the mother, but the risk to the fetus and newborn is substantial. The timing of GBS disease suggests that a maternal vaccine given in the late second or early third trimester of pregnancy would prevent most maternal cases.
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Affiliation(s)
- Jennifer Hall
- Department of Reproductive Health Research, University College London Institute for Women’s Health, United Kingdom
| | - Nadine Hack Adams
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Theresa Lamagni
- Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, London,United Kingdom
| | - Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | | | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
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297
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Tann CJ, Martinello KA, Sadoo S, Lawn JE, Seale AC, Vega-Poblete M, Russell NJ, Baker CJ, Bartlett L, Cutland C, Gravett MG, Ip M, Le Doare K, Madhi SA, Rubens CE, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Heath PT. Neonatal Encephalopathy With Group B Streptococcal Disease Worldwide: Systematic Review, Investigator Group Datasets, and Meta-analysis. Clin Infect Dis 2017; 65:S173-S189. [PMID: 29117330 PMCID: PMC5850525 DOI: 10.1093/cid/cix662] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neonatal encephalopathy (NE) is a leading cause of child mortality and longer-term impairment. Infection can sensitize the newborn brain to injury; however, the role of group B streptococcal (GBS) disease has not been reviewed. This paper is the ninth in an 11-article series estimating the burden of GBS disease; here we aim to assess the proportion of GBS in NE cases. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups reporting GBS-associated NE. Meta-analyses estimated the proportion of GBS disease in NE and mortality risk. UK population-level data estimated the incidence of GBS-associated NE. RESULTS Four published and 25 unpublished datasets were identified from 13 countries (N = 10436). The proportion of NE associated with GBS was 0.58% (95% confidence interval [CI], 0.18%-.98%). Mortality was significantly increased in GBS-associated NE vs NE alone (risk ratio, 2.07 [95% CI, 1.47-2.91]). This equates to a UK incidence of GBS-associated NE of 0.019 per 1000 live births. CONCLUSIONS The consistent increased proportion of GBS disease in NE and significant increased risk of mortality provides evidence that GBS infection contributes to NE. Increased information regarding this and other organisms is important to inform interventions, especially in low- and middle-resource contexts.
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Affiliation(s)
- Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom;
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom;
| | - Kathryn A Martinello
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom;
- Institute for Women’s Health, University College London, United Kingdom
| | - Samantha Sadoo
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom;
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom;
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom;
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom;
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Maira Vega-Poblete
- Neonatal Medicine, University College London Hospitals NHS Foundation Trust, United Kingdom;
- Medical School, University College London, United Kingdom
| | - Neal J Russell
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom;
- King’s College London, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College London, United Kingdom
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington
- Department of Global Health, University of Washington, Seattle
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
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Bianchi-Jassir F, Seale AC, Kohli-Lynch M, Lawn JE, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Rubens CE. Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017; 65:S133-S142. [PMID: 29117329 PMCID: PMC5850429 DOI: 10.1093/cid/cix661] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks' gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. RESULTS We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P < .001). CONCLUSIONS From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.
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Affiliation(s)
- Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas;
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington;
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | | | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington;
- Department of Global Health, University of Washington, Seattle
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