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Tummala S, Wang MJ, Srivastava A, Claus L, Abbas D, Alexander M, Young S, Comfort A, Yarrington C. Group B Streptococcus Infection and Obstetric Hemorrhage Risk. Matern Child Health J 2024; 28:1258-1263. [PMID: 38461475 DOI: 10.1007/s10995-023-03892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To elucidate the association between GBS infection and maternal risk for obstetric hemorrhage (OBH) and OBH-related morbidities (OBH-M). METHODS This was a retrospective cohort study of all deliveries with a documented GBS status at a single large academic medical center from 2018 to 2019. GBS status was determined by either urine culture or rectovaginal culture collected during the antepartum period. The primary outcomes were quantitative blood loss (QBL), OBH, and a composite of OBH-M. Secondary outcomes were individual components of the OBH-M composite and frequency of hemorrhage-related interventions utilized intrapartum and postpartum. A stratified analysis was conducted examining only patients who were diagnosed intrapartum with an intrapartum intraamniotic infection (III). RESULTS Of 4679 pregnant individuals who delivered a live infant between January 1, 2018 and January 1,2019 with a documented GBS status, 1,487 were identified as GBS positive (+) and 3192 were identified as GBS negative (-). The GBS + group did not have significantly higher QBL (p = 0.29) or rate of OBH (p = 0.35). There were no significant differences by GBS status in OBH morbidity (p = 0.79) or its individual components or frequency of individual pharmacologic or non-pharmacologic OBHrelated interventions. There were also no significant differences by GBS status among patients with an III. CONCLUSIONS FOR PRACTICE GBS infection at the time of delivery was not associated with increased risk for OBH or OBH-M. Further research is needed to further explore the relationship between peripartum infections and OBH risk.
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Affiliation(s)
- Swetha Tummala
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Michelle J Wang
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, Boston, MA, 02118, USA
| | | | - Lindsey Claus
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Diana Abbas
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Megan Alexander
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sara Young
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ashley Comfort
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, Boston, MA, 02118, USA
| | - Christina Yarrington
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, Boston, MA, 02118, USA
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Duan H, Huang W, Lv Q, Liu P, Li Q, Kong D, Sun X, Zhang X, Jiang Y, Chen S. Using Surface Immunogenic Protein as a Carrier Protein to Elicit Protective Antibody to Multiple Serotypes for Candidate Group B Streptococcal Glycan Conjugate Vaccines. Vaccines (Basel) 2024; 12:573. [PMID: 38932301 PMCID: PMC11209137 DOI: 10.3390/vaccines12060573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/15/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024] Open
Abstract
Group B Streptococcus (GBS) is a life-threatening opportunistic pathogen, particularly in pregnant women, infants, and the elderly. Currently, maternal vaccination is considered the most viable long-term option for preventing GBS mother-to-infant infection, and two polysaccharide conjugate vaccines utilizing CRM197 as a carrier protein have undergone clinical phase II trials. Surface immunogenic protein (Sip), present in all identified serotypes of GBS strains so far, is a protective surface protein of GBS. In this study, the type Ia capsular polysaccharide (CPS) of GBS was utilized as a model to develop candidate antigens for a polysaccharide conjugate vaccine by coupling it with the Sip of GBS and the traditional carrier protein CRM197. Serum analysis from immunized New Zealand rabbits and CD1 mice revealed that there was no significant difference in antibody titers between the Ia-Sip group and Ia-CRM197 group; however, both were significantly higher than those observed in the Ia polysaccharide group. Opsonophagocytosis and passive immune protection results using rabbit serum indicated no significant difference between the Ia-Sip and Ia-CRM197 groups, both outperforming the Ia polysaccharide group. Furthermore, serum from the Ia-Sip group had a cross-protective effect on multiple types of GBS strains. The challenge test results in CD1 mice demonstrated that the Ia-Sip group provided complete protection against lethal doses of bacteria and also showed cross-protection against type III strain. Our study demonstrates for the first time that Ia-Sip is immunogenic and provides serotype-independent protection in glycan conjugate vaccines, which also indicates Sip may serve as an excellent carrier protein for GBS glycan conjugate vaccines and provide cross-protection against multiple GBS strains.
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Affiliation(s)
- Huiqi Duan
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Wenhua Huang
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Qingyu Lv
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Peng Liu
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Qian Li
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Decong Kong
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Xuyang Sun
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
- Tianjin Key Laboratory of Agricultural Animal Breeding and Healthy Husbandry, College of Animal Science and Veterinary Medicine, Tianjin Agricultural University, Tianjin 300392, China
| | - Xinran Zhang
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Yongqiang Jiang
- School of Basic Medical Sciences, Anhui Medical University, Hefei 230032, China
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
| | - Shaolong Chen
- State Key Laboratory of Pathogen and Biosecurity, Academy of Military Medical Sciences, Beijing 100071, China
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Seedat F, Procter S, Dangor Z, Leahy S, Santhanam S, John HB, Bassat Q, Aerts C, Abubakar A, Nasambu C, Libster R, Yanotti CS, Paul P, Chanda J, Gonçalves BP, Horváth-Puhó E, Lawn JE, Jit M. Long-term healthcare utilisation, costs and quality of life after invasive group B Streptococcus disease: a cohort study in five low-income and middle-income countries. BMJ Glob Health 2024; 9:e014367. [PMID: 38749511 PMCID: PMC11097862 DOI: 10.1136/bmjgh-2023-014367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION There are no published data on the long-term impact of invasive group B Streptococcus disease (iGBS) on economic costs or health-related quality of life (HRQoL) in low-income and middle-income countries. We assessed the impact of iGBS on healthcare utilisation, costs and HRQoL in Argentina, India, Kenya, Mozambique and South Africa. METHODS Inpatient and outpatient visits, out-of-pocket (OOP) healthcare payments in the 12 months before study enrolment, and health-state utility of children and caregivers (using the EuroQol 5-Dimensions-3-Level) were collected from iGBS survivors and an unexposed cohort matched on site, age at recruitment and sex. We used logistic or Poisson regression for analysing healthcare utilisation and zero-inflated gamma regression models for family and health system costs. For HRQoL, we used a zero-inflated beta model of disutility pooled data. RESULTS 161 iGBS-exposed and 439 unexposed children and young adults (age 1-20) were included in the analysis. Compared with unexposed participants, iGBS was associated with increased odds of any healthcare utilisation in India (adjusted OR 11.2, 95% CI 2.9 to 43.1) and Mozambique (6.8, 95% CI 2.2 to 21.1) and more frequent healthcare visits (adjusted incidence rate ratio (IRR) for India 1.7 (95% CI 1.4 to 2.2) and for Mozambique 6.0 (95% CI 3.2 to 11.2)). iGBS was also associated with more frequent days in inpatient care in India (adjusted IRR 4.0 (95% CI 2.3 to 6.8) and Kenya 6.4 (95% CI 2.9 to 14.3)). OOP payments were higher in the iGBS cohort in India (adjusted mean: Int$682.22 (95% CI Int$364.28 to Int$1000.16) vs Int$133.95 (95% CI Int$72.83 to Int$195.06)) and Argentina (Int$244.86 (95% CI Int$47.38 to Int$442.33) vs Int$52.38 (95% CI Int$-1.39 to Int$106.1)). For all remaining sites, differences were in the same direction but not statistically significant for almost all outcomes. Health-state disutility was higher in iGBS survivors (0.08, 0.04-0.13 vs 0.06, 0.02-0.10). CONCLUSION The iGBS health and economic burden may persist for years after acute disease. Larger studies are needed for more robust estimates to inform the cost-effectiveness of iGBS prevention.
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Affiliation(s)
- Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Simon Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa
| | - Sridhar Santhanam
- Neonatology Department, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Hima B John
- Neonatology Department, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Manhica, Maputo, Mozambique
- Hospital Clínic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Celine Aerts
- Hospital Clínic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Human Development, The Aga Khan University - Kenya, Nairobi, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chanda
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Bronner P Gonçalves
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Leung S, Collett CF, Allen L, Lim S, Maniatis P, Bolcen SJ, Alston B, Patel PY, Kwatra G, Hall T, Thomas S, Taylor S, Le Doare K, Gorringe A. Development of A Standardized Opsonophagocytosis Killing Assay for Group B Streptococcus and Assessment in an Interlaboratory Study. Vaccines (Basel) 2023; 11:1703. [PMID: 38006035 PMCID: PMC10675794 DOI: 10.3390/vaccines11111703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
The placental transfer of antibodies that mediate bacterial clearance via phagocytes is likely important for protection against invasive group B Streptococcus (GBS) disease. A robust functional assay is essential to determine the immune correlates of protection and assist vaccine development. Using standard reagents, we developed and optimized an opsonophagocytic killing assay (OPKA) where dilutions of test sera were incubated with bacteria, baby rabbit complement (BRC) and differentiated HL60 cells (dHL60) for 30 min. Following overnight incubation, the surviving bacteria were enumerated and the % bacterial survival was calculated relative to serum-negative controls. A reciprocal 50% killing titer was then assigned. The minimal concentrations of anti-capsular polysaccharide (CPS) IgG required for 50% killing were 1.65-3.70 ng/mL (depending on serotype). Inhibition of killing was observed using sera absorbed with homologous CPS but not heterologous CPS, indicating specificity for anti-CPS IgG. The assay performance was examined in an interlaboratory study using residual sera from CPS-conjugate vaccine trials with international partners in the Group B Streptococcus Assay STandardisatiON (GASTON) Consortium. Strong correlations of reported titers between laboratories were observed: ST-Ia r = 0.88, ST-Ib r = 0.91, ST-II r = 0.91, ST-III r = 0.90 and ST-V r = 0.94. The OPKA is an easily transferable assay with accessible standard reagents and will be a valuable tool to assess GBS-specific antibodies in natural immunity and vaccine studies.
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Affiliation(s)
- Stephanie Leung
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Clare F. Collett
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Lauren Allen
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Suzanna Lim
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Pete Maniatis
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | - Shanna J. Bolcen
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | | | - Palak Y. Patel
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (P.M.)
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa;
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Tom Hall
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Stephen Thomas
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Stephen Taylor
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
| | - Kirsty Le Doare
- Maternal and Neonatal Vaccine Immunology Research Group, Centre for Neonatal and Paediatric Infection, St George’s, University of London, London SW17 0RE, UK; (S.L.); (T.H.)
| | - Andrew Gorringe
- UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK (A.G.)
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Trotter CL, Alderson M, Dangor Z, Ip M, Le Doare K, Nakabembe E, Procter SR, Sekikubo M, Lambach P. Vaccine value profile for Group B streptococcus. Vaccine 2023; 41 Suppl 2:S41-S52. [PMID: 37951694 DOI: 10.1016/j.vaccine.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 11/14/2023]
Abstract
Group B streptococcus (GBS) is a major global cause of neonatal meningitis, sepsis and pneumonia, with an estimated 91,000 infant deaths per year and an additional 46,000 stillbirths. GBS infection in pregnancy is also associated with adverse maternal outcomes and preterm births. As such, the World Health Organization (WHO) prioritised the development of a GBS vaccine suitable for use in pregnant women and use in LMICs, where the burden of disease is highest. Several GBS vaccines are in clinical development. The WHO Defeating Meningitis by 2030 has set a target of 2026 for vaccine licensure. This 'Vaccine Value Profile' (VVP) for GBS is intended to provide a high-level, holistic assessment of the information and data that are currently available to inform the potential public health, economic and societal value of pipeline vaccines and vaccine-like products. This VVP was developed by a working group of subject matter experts from academia, non-profit organizations, public private partnerships and multi-lateral organizations, and in collaboration with stakeholders from the WHO regions of AFR, AMR, EUR, WPR. All contributors have extensive expertise on various elements of the GBS VVP and collectively aimed to identify current research and knowledge gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Caroline L Trotter
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
| | - Mark Alderson
- PATH, 2201 Westlake Avenue, Suite,200, Seattle, WA 98121, USA.
| | - Ziyaad Dangor
- WITS VIDA Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, 30 Chris Hani Road, Diepkloof, Soweto, 1862 Johannesburg, South Africa.
| | - Margaret Ip
- The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong, China.
| | - Kirsty Le Doare
- St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Eve Nakabembe
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Simon R Procter
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Musa Sekikubo
- Makerere University School of Medicine, P.O. Box 7072, Kampala, Uganda.
| | - Philipp Lambach
- World Health Organization, Avenue Appia, Geneva CH-1211, Switzerland.
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Carboni F, Cozzi R, Romagnoli G, Tuscano G, Balocchi C, Buffi G, Bodini M, Brettoni C, Giusti F, Marchi S, Brogioni G, Brogioni B, Cinelli P, Cappelli L, Nocciolini C, Senesi S, Facciotti C, Frigimelica E, Fabbrini M, Stranges D, Savino S, Maione D, Adamo R, Wizel B, Margarit I, Romano MR. Proof of concept for a single-dose Group B Streptococcus vaccine based on capsular polysaccharide conjugated to Qβ virus-like particles. NPJ Vaccines 2023; 8:152. [PMID: 37803013 PMCID: PMC10558462 DOI: 10.1038/s41541-023-00744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
A maternal vaccine to protect neonates against Group B Streptococcus invasive infection is an unmet medical need. Such a vaccine should ideally be offered during the third trimester of pregnancy and induce strong immune responses after a single dose to maximize the time for placental transfer of protective antibodies. A key target antigen is the capsular polysaccharide, an anti-phagocytic virulence factor that elicits protective antibodies when conjugated to carrier proteins. The most prevalent polysaccharide serotypes conjugated to tetanus or diphtheria toxoids have been tested in humans as monovalent and multivalent formulations, showing excellent safety profiles and immunogenicity. However, responses were suboptimal in unprimed individuals after a single shot, the ideal schedule for vaccination during the third trimester of pregnancy. In the present study, we obtained and optimized self-assembling virus-like particles conjugated to Group B Streptococcus capsular polysaccharides. The resulting glyco-nanoparticles elicited strong immune responses in mice already after one immunization, providing pre-clinical proof of concept for a single-dose vaccine.
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Dhar N, Mohamed E, Kirstein F, Williams M, Dorasamy S, van Zyl P, Robertson MJ, Anderson T, Harden LM, Jardine K, Veeraraghavan B, Wilson S, Tippoo P, Madhi SA, Kwatra G. Immune responses against group B Streptococcus monovalent and pentavalent capsular polysaccharide tetanus toxoid conjugate vaccines in Balb/c mice. iScience 2023; 26:107380. [PMID: 37575182 PMCID: PMC10415928 DOI: 10.1016/j.isci.2023.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/31/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Immunization of pregnant women with Group B Streptococcus (GBS) capsular polysaccharide (CPS) conjugate vaccine (CV) could protect young infants against invasive GBS disease. We evaluated the immunogenicity of investigational five GBS monovalent (serotypes Ia, Ib, II, III, and V) CPS-tetanus toxoid (TT)-CV with adjuvant and GBS pentavalent CPS-TT-CV with adjuvant (GBS5-CV-adj) and without adjuvant (GBS5-CV-no-adj), in Balb/c mice. Aluminum phosphate was the adjuvant in the formulations, where included. The homotypic immunoglobulin G (IgG) geometric mean concentration (GMC) and opsonophagocytic activity (OPA) geometric mean titer (GMT) did not differ after the third dose of the GBS5-CV-adj vaccine compared with the monovalent counterparts for all five serotypes. The GBS5-CV-adj induced higher post-vaccination serotype-specific IgG GMCs and OPA GMTs compared to GBS5-CV-no_adj. The GBS5-CV with and without adjuvant should be considered for further development as a potential vaccine for pregnant women to protect their infants against invasive GBS disease.
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Affiliation(s)
- Nisha Dhar
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kimberly Jardine
- Wits Research Animal Facility, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Li J, Zhou M, He C, Liang F. Group B Streptococcus infection-induced ovarian vein thrombosis identified during cesarean section: A case report and a literature review. Medicine (Baltimore) 2023; 102:e34141. [PMID: 37352049 PMCID: PMC10289690 DOI: 10.1097/md.0000000000034141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Ovarian vein thrombosis (OVT) is a rare yet potentially life-threatening condition associated with thromboembolic events. Group B Streptococcus (GBS) is a type of β-hemolytic Gram-positive bacterium known for asymptomatic colonization in the lower genital and gastrointestinal tracts. Here we reported a 35-year-old multiparous woman with gestational diabetes who suffered from placental abruption, stillbirth, OVT, septic shock, and renal failure due to severe GBS infection. PATIENT CONCERNS A 35-year-old woman with gestational diabetes presented with acute and sustained lower abdominal cramping, vaginal bleeding, and fever at 35 gestational weeks. DIAGNOSES Based on preoperative ultrasound and intraoperative findings, the patient was diagnosed with placental abruption, intrauterine fetal demise, and right OVT. GBS was cultured from the amniotic fluid obtained during cesarean section. INTERVENTIONS The patient underwent a right adnexectomy during a cesarean section and received intravenous antibiotics. Subsequently, an ultrasound-guided uterine curettage was performed due to recurrent fever. OUTCOMES After a prolonged course of intravenous antibiotics for over a month, the patient recovered and was discharged from the hospital. LESSONS This case underscores the need for early initiation of anticoagulant protocols in cases of OVT, particularly when GBS infection is identified as a predisposing factor. Further research and awareness are warranted to better understand the relationship between GBS infection and OVT and to optimize management strategies in such cases.
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Affiliation(s)
- Jianqiong Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meifang Zhou
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chaoman He
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengbing Liang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
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Maternity care provider acceptance of a future Group B Streptococcus vaccine - A qualitative study in three countries. Vaccine 2023; 41:2013-2021. [PMID: 36803900 DOI: 10.1016/j.vaccine.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/26/2023] [Accepted: 02/11/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION There are vaccines in clinical trials that target the bacterium Group B Streptococcus (GBS). When approved, GBS vaccines will be intended for administration to pregnant women to prevent infection in their infants. The success of any vaccine will depend on its' uptake in the population. Experience with prior maternal vaccines, e.g. influenza, Tdap and COVID-19 vaccines, teaches us that acceptance of vaccines, especially if novel, is challenging for pregnant women, and that provider recommendation is a key driver of vaccine uptake. METHODS This study investigated attitudes of maternity care providers towards the introduction of a GBS vaccine in three countries (the United States (US), Ireland, and the Dominican Republic (DR)) with different GBS prevalence and prevention practices. Semi-structured interviews with maternity care providers were transcribed and coded for themes. The constant comparative method, and inductive theory building were used to develop conclusions. RESULTS Thirty-eight obstetricians, 18 general practitioners and 14 midwives participated. There was variability in provider attitudes towards a hypothetical GBS vaccine. Responses ranged from enthusiasm to doubts over the need for a vaccine. Attitudes were influenced by perceived additional benefits of a vaccine over current strategy and confidence in the safety of vaccines during pregnancy. Knowledge, experience and approaches to GBS prevention differed geographically and according to provider type, and influenced how participants assessed the risks and benefits of a GBS vaccine. CONCLUSION Maternity care providers are engaged in the topic of GBS management and there is opportunity to leverage attitudes and beliefs that will support a strong recommendation for a GBS vaccine. However, knowledge of GBS, and of the limitations of current prevention strategies vary among providers in different regions, and between different provider types. Targeted educational efforts with antenatal providers should focus on highlighting safety data the potential benefits of vaccination over current strategies.
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10
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Babakanrad E, Mohammadian T, Esmaeili D, Behzadi P. Designing and cloning of fusion protein CpsA-CpsC-L-ACAN. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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11
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Choi Y, Han HS, Chong GO, Le TM, Nguyen HDT, Lee OEM, Lee D, Seong WJ, Seo I, Cha HH. Updates on Group B Streptococcus Infection in the Field of Obstetrics and Gynecology. Microorganisms 2022; 10:microorganisms10122398. [PMID: 36557651 PMCID: PMC9780959 DOI: 10.3390/microorganisms10122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a Gram-positive bacterium that is commonly found in the gastrointestinal and urogenital tracts. However, its colonization during pregnancy is an important cause of maternal and neonatal morbidity and mortality worldwide. Herein, we specifically looked at GBS in relation to the field of Obstetrics (OB) along with the field of Gynecology (GY). In this review, based on the clinical significance of GBS in the field of OBGY, topics of how GBS is being detected, treated, and should be prevented are addressed.
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Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hyung-Soo Han
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Tan Minh Le
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Duc Thi Nguyen
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Olive EM Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Incheol Seo
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
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12
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ICU Management of Invasive β-Hemolytic Streptococcal Infections. Infect Dis Clin North Am 2022; 36:861-887. [DOI: 10.1016/j.idc.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances. Obstet Gynecol Surv 2022; 77:753-762. [PMID: 36477387 DOI: 10.1097/ogx.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. Objective The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines. Evidence Acquisition Original research articles, review articles, and guidelines on GBS were reviewed. Results The following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues. Conclusions Although all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.
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Ali M, Alamin MA, A. Ali G, Alzubaidi K, Ali B, Ismail A, Daghfal J, Almaslamani M, Hadi HA. Microbiological and clinical characteristics of invasive Group B Streptococcal blood stream infections in children and adults from Qatar. BMC Infect Dis 2022; 22:881. [PMID: 36434535 PMCID: PMC9701022 DOI: 10.1186/s12879-022-07801-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Group B Streptococci (GBS) colonize almost one third of human gastrointestinal and genitourinary tracts, particularly in females. The aim of this study is to evaluate the epidemiology, microbiological characteristics, and clinical outcomes of invasive GBS disease in Qatar from all age groups. METHODS A retrospective study was conducted on patients with confirmed GBS blood stream infections during the period between January 2015 and March 2019. Microbiological identification was performed using automated BD PhoenixTM system, while additional antimicrobial susceptibility tests were performed using E test and disc diffusion methods. RESULT During the four years period, the incidence steadily rose from 1.48 to 2.09 cases per 100.000 population. Out of 196 confirmed cases of invasive GBS infections, the majority were females (63.7%, 125/196) of which 44.8% were pregnant and 53.6% were colonized. Three distinct affected age groups were identified: children ≤ 4 years of age (35.7%), young adults 25-34 (20.9%) and the elderly ≥ 65 year (17.4%). Presenting symptoms were mild with fever in 53% of cases while 89% of cases had Pitt bacteraemia score of ≤ 2. Isolates were universally sensitive to penicillin, ceftriaxone, and vancomycin at 100% but with significant resistance to erythromycin (49%) and clindamycin (28.6%) while 16.8% had inducible clindamycin resistance. Clinical outcomes showed cure rate of 87.25% with complications in (8.76%) and 4% mortality. CONCLUSION There is a rising trend of Group B Streptococcal blood stream infections in Qatar with significantly high clindamycin and erythromycin resistance rates. Universal susceptibility rates were demonstrated for penicillin, ceftriaxone, and vancomycin.
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Affiliation(s)
- Maisa Ali
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Mohammed A. Alamin
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Gawahir A. Ali
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Khalid Alzubaidi
- grid.467063.00000 0004 0397 4222Paediatric Infectious Diseases, Sidra Medicine, Doha, Qatar
| | - Bashir Ali
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdellatif Ismail
- grid.413548.f0000 0004 0571 546XInternal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Daghfal
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Muna Almaslamani
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
| | - Hamad Abdel Hadi
- grid.413548.f0000 0004 0571 546XCommunicable Diseases Centre, Infectious Diseases Department, Hamad Medical Corporation, P. O. Box 3050, Doha, Qatar
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Zhang Y, Liang S, Zhang S, Zhang S, Yu Y, Huochun Y, Liu Y, Zhang W, Liu G. Development and evaluation of a multi-epitope subunit vaccine against group B Streptococcus infection. Emerg Microbes Infect 2022; 11:2371-2382. [PMID: 36069613 PMCID: PMC9543083 DOI: 10.1080/22221751.2022.2122585] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a multi-host pathogen, even causing life-threatening infections in newborns. Vaccination with GBS crossed serotypes vaccine is one of the best options for long-term infection control. Here we built a comprehensive in silico epitope-prediction workflow pipeline to design a multivalent multiepitope-based subunit vaccine containing 11 epitopes against Streptococcus agalactiae (MVSA). All epitopes in MVSA came from the proteins which were antigenic-confirmed, virulent-associated, surface-exposed and conserved in ten GBS serotypes. The in-silico analysis showed MVSA had potential to evoke strong immune responses and enable worldwide population coverage. To validate MVSA protection efficacy against GBS infection, immune protection experiments were performed in a mouse model. Importantly, MVSA induced a high titre of antibodies, significant proliferation of mice splenocytes and elicited strong protection against lethal-dose challenge with a survival rate of 100% in mice after three vaccinations. Meanwhile, the polyclonal antibody against MVSA did not only inhibit for growth of GBS from six crucial serotypes in vitro, but also protect 100% naive mice from GBS lethal challenge. These active and passive immunity assay results suggested that MVSA could therefore be an efficacious multi-epitope vaccine against GBS infection.
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Affiliation(s)
- Yumin Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Song Liang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Shiyu Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Shidan Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yong Yu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yao Huochun
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Yongjie Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China
| | - Wei Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China.,Sanya Institute of Nanjing Agricultural University, Sanya, China
| | - Guangjin Liu
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China.,OIE Reference Laboratory for Swine Streptococcosis, Nanjing, China.,MOE Joint International Research Laboratory of Animal Health and Food Safety, Nanjing, China.,Key Laboratory of Animal Bacteriology, Ministry of Agriculture, Nanjing, China.,Sanya Institute of Nanjing Agricultural University, Sanya, China
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16
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Babakanrad E, Mohammadian T, Esmaeili D, Behzadi P. Efficacy of the Apoptotic Activity of CpsA-CpsC-L-ACAN Fusion Peptide against HeLa Cell Line. MOLECULAR GENETICS, MICROBIOLOGY AND VIROLOGY 2022. [DOI: 10.3103/s089141682203003x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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Brokaw A, Nguyen S, Quach P, Orvis A, Furuta A, Johansson-Lindbom B, Fischer PB, Rajagopal L. A Recombinant Alpha-Like Protein Subunit Vaccine (GBS-NN) Provides Protection in Murine Models of Group B Streptococcus Infection. J Infect Dis 2022; 226:177-187. [PMID: 35429401 PMCID: PMC9890916 DOI: 10.1093/infdis/jiac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) transmission during pregnancy causes preterm labor, stillbirths, fetal injury, or neonatal infections. Rates of adult infections are also rising. The GBS-NN vaccine, engineered by fusing N-terminal domains of GBS Alpha C and Rib proteins, is safe in healthy, nonpregnant women, but further assessment is needed for use during pregnancy. Here, we tested GBS-NN vaccine efficacy using mouse models that recapitulate human GBS infection outcomes. METHODS Following administration of GBS-NN vaccine or adjuvant, antibody profiles were compared by ELISA. Vaccine efficacy was examined by comparing infection outcomes in GBS-NN vaccinated versus adjuvant controls during systemic and pregnancy-associated infections, and during intranasal infection of neonatal mice following maternal vaccination. RESULTS Vaccinated mice had higher GBS-NN-specific IgG titers versus controls. These antibodies bound alpha C and Rib on GBS clinical isolates. Fewer GBS were recovered from systemically challenged vaccinated mice versus controls. Although vaccination did not eliminate GBS during ascending infection in pregnancy, vaccinated dams experienced fewer in utero fetal deaths. Additionally, maternal vaccination prolonged neonatal survival following intranasal GBS challenge. CONCLUSIONS These findings demonstrate GBS-NN vaccine efficacy in murine systemic and perinatal GBS infections and suggest that maternal vaccination facilitates the transfer of protective antibodies to neonates.
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Affiliation(s)
- Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Phoenicia Quach
- Present affiliation: Phoenicia Quach, Universal Cells, Seattle 98121, Washington
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, Washington, USA,Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Lakshmi Rajagopal
- Correspondence: L. Rajagopal, PhD, Department of Pediatrics, University of Washington, Seattle Children’s Hospital Research Institute, 307 Westlake Ave N, Seattle, WA 98109 ()
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18
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Dominguez K, Randis TM. Toward the development of a protein-based group B Streptococcus vaccine. Cell Rep Med 2022; 3:100536. [PMID: 35243427 PMCID: PMC8861943 DOI: 10.1016/j.xcrm.2022.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical trials of protein-based vaccines to prevent Group B streptococcal infections are underway. In this issue of Cell Reports Medicine, Pawlowski et al.1 provide an extensive characterization of the immune response generated by the recently tested GBS-NN vaccine.
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Affiliation(s)
- Kristen Dominguez
- Department of Molecular Medicine, University of South Florida; Morsani School of Medicine
| | - Tara M Randis
- Department of Molecular Medicine, University of South Florida; Morsani School of Medicine.,Department of Pediatrics, University of South Florida; Morsani School of Medicine
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McLeod E, Mason C, Swainston K. Parents experiences of having an infant with early onset group B streptococcus infection. Br J Health Psychol 2021; 27:777-788. [PMID: 34806260 DOI: 10.1111/bjhp.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 10/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study explores parents lived experience of having an infant with early onset group B streptococcus (GBS). DESIGN The study adopts a qualitative approach and a phenomenological framework with written autobiographical accounts as the method of data collection. METHODS Twenty-seven parents wrote first-hand accounts of their experience of having an infant with early onset GBS. Participants documented their experiences in their own way, reporting their thoughts and feelings, experiences, and events that were meaningful to them. RESULTS Four themes were developed from data analysis: 'bonding'; 'grief'; 'communication and information provision'; and 'future family'. CONCLUSIONS The study findings demonstrate the complexity of emotions within parent's experiences and highlight grief and loss as a core component of these experiences. Medical intervention, while acknowledged as being vital and in many cases lifesaving, was viewed as a disruption to early bonding experiences resulting in sadness and guilt. Variation in information provision, communication about this infection, and feeling that their infant's illness and/or death were preventable added to the sense of loss. Breakdowns in interpersonal communications with partners and family were commonly described and experiences of early onset GBS had implications for decision-making around future pregnancies.
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Affiliation(s)
- Emma McLeod
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Celia Mason
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Katherine Swainston
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
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Malvolti S, Pecenka C, Mantel C, Malhame M, Lambach P. A financial and global demand analysis to inform decisions for funding and clinical development of GBS vaccines for pregnant women. Clin Infect Dis 2021; 74:S70-S79. [PMID: 34725684 PMCID: PMC8775646 DOI: 10.1093/cid/ciab782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Despite group B Streptococcus (GBS) being a leading cause of maternal and infant morbidity and mortality, no vaccine is currently available. To inform vaccine developers, countries, and funders, we analyzed the key factors likely to influence the demand for a GBS vaccine and the long-term financial sustainability for a vaccine developer. Methods Using population-based forecasting, we estimated the demand for a GBS vaccine; using a discounted cash flow model we estimated the financial viability for a vaccine developer. Results Demand for this vaccine can be significant if countries adopt policy recommendations for use, in particular, the largest ones, most of which have a burden that justifies use of the vaccine, and if financing for the vaccine is made available either by countries or by funding mechanisms such as Gavi, the Vaccine Alliance. Conclusions This analysis suggests the potential for financial and commercial viability for a vaccine developer pursuing the commercialization of a GBS vaccine. Risks exists in relation to the clinical trial design and costs, the level of competition, countries’ ability to pay, the administration schedule, and the availability of policies that encourage use of the vaccine. To reduce those risks and ensure equitable access to a GBS vaccine, the role of donors or financers can prove very important, as can a coordinated operational research agenda that aims at clarifying those areas of uncertainty.
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Affiliation(s)
| | | | | | | | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Bob-Manuel M, McGee L, Igunma JA, Alex-Wele MA, Obunge OK, Wariso KT. Whole genome sequence based capsular typing and antimicrobial resistance prediction of Group B streptococcal isolates from colonized pregnant women in Nigeria. BMC Genomics 2021; 22:627. [PMID: 34425756 PMCID: PMC8382210 DOI: 10.1186/s12864-021-07929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Streptococcus agalactiae (Group B Streptococcus, GBS) is one of the major bacterial pathogens responsible for neonatal sepsis. Whole genome sequencing has, in recent years, emerged as a reliable tool for capsular typing and antimicrobial resistance prediction. This study characterized vaginal and rectal isolates of Group B Streptococcus obtained from pregnant women in Port Harcourt, Nigeria using a whole-genome sequence-based approach. RESULTS Capsular types Ia, Ib, II, III, IV and V were detected among the 43 isolates sequenced. Twelve sequence types (STs) were identified, with ST19 (n = 9, 27.3 %) and ST486 (n = 5, 15.2 %) the most frequent among non-duplicated isolates. Of the alpha-like proteins (alp) identified, Alp1 was the most prevalent in 11 (33.3 %) isolates. Macrolide and lincosamide resistance determinants were present in 15 (45.5 %) isolates; ermB was detected in 1 (3 %), ermTR in 7 (21.2 %) isolates, lnu gene was detected in 6 (18.2 %) and mef was identified in 3 (9.1 %) isolates. Resistance of GBS to erythromycin and clindamycin (predicted from presence of erm or mef genes) was found to be 30.3 % and 24.2 %, respectively. All isolates were predicted resistant to tetracycline with only the tetM gene identified. Fluoroquinolone-resistance conferring substitutions in gyrA + parC were detected in 9 (27.3 %) isolates and chloramphenicol resistance was predicted from presence of aac6'-aph2 gene in 11 (33.3 %). CONCLUSIONS The data available from the whole genome sequencing of these isolates offers a small but insightful description of common serotypes and resistance features within colonizing GBS in Nigeria.
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Affiliation(s)
- Mienye Bob-Manuel
- Department of Medical Microbiology and Parasitology, Rivers State University Teaching Hospital, Port Harcourt, Nigeria
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, GA, 30329, Atlanta, USA.
| | - Jeremiah A Igunma
- Department of Medical Microbiology, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Mary A Alex-Wele
- Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Orikomaba K Obunge
- Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Kennedy T Wariso
- Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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22
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Yuan XY, Liu HZ, Liu JF, Sun Y, Song Y. Pathogenic mechanism, detection methods and clinical significance of group B Streptococcus. Future Microbiol 2021; 16:671-685. [PMID: 34098731 DOI: 10.2217/fmb-2020-0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Group B Streptococcus (GBS) is the main pathogen of perinatal infection. It can lead to adverse pregnancy, maternal infection, premature delivery, abortion, stillbirth and a series of adverse maternal and infant outcomes such as neonatal sepsis, meningitis or pneumonia during delivery. In order to reduce the infection of perinatal pregnant and the adverse pregnancy outcome, more attention should be paid in the clinical practice, screening efforts, universal detection of GBS infection for pregnant women and preventive treatment for the possible mother infant infection. In this study, the biological characteristics, immunophenotype, major pathogenic mechanism, laboratory test methods and clinical significance of GBS are summarized.
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Affiliation(s)
- Xiao-Yan Yuan
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Hai-Zhu Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Jia-Fei Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China.,Department of Medical Laboratory Sciences, Weifang Medical University, Weifang, Shandong, 261000, PR China
| | - Yong Sun
- Department of Clinical Lab, Yantai Laiyang Central Hospital, Yantai, Shandong, 264200, PR China
| | - Yu Song
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
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23
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Johm P, Nkoum N, Ceesay A, Mbaye EH, Larson H, Kampmann B. Factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal. Vaccine 2021; 39:3926-3934. [PMID: 34088509 DOI: 10.1016/j.vaccine.2021.05.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vaccination during pregnancy can protect pregnant women and their babies from infectious diseases. Tetanus vaccine, also known as tetanus toxoid, is the only vaccine given to pregnant women in The Gambia and Senegal, where it is given by antenatal care providers as part of the Expanded Programme on Immunization. A qualitative study was undertaken to explore factors influencing acceptance of vaccination during pregnancy in The Gambia and Senegal. METHODS Focus group discussions and in-depth interviews were conducted across urban and rural settlements of The Gambia and Senegal. We explored the knowledge, attitudes, and perceptions of 152 women who were either pregnant or with an infant. NVivo 11 Qualitative Data Analysis Software was used for management and thematic analysis of the data. RESULTS Women had sufficient knowledge of the need for tetanus vaccine from different information sources but insufficient knowledge of tetanus causes, signs and symptoms. Tetanus vaccine was perceived to be safe and side effects such as pain and swelling at site of injection did not deter uptake of future doses. Women overall had confidence in their sources of vaccine information and the health care workers who administered maternal vaccinations. Their willingness to accept vaccination during pregnancy was particularly influenced by their husbands and trusted healthcare workers. Women across all sites mentioned they would accept new maternal vaccines if they are sensitized beforehand about any potential risks and benefits to them and their babies. CONCLUSION Vaccine acceptance can be influenced by several factors including contextual, individual or group influences and vaccine or vaccination-specific issues. Women across The Gambia and Senegal are generally vaccine acceptors with confidence in the health care workers who vaccinate them and few concerns about maternal vaccines. Women's acceptance of vaccination during pregnancy is based on previous vaccination experiences and individual weighing of risks and benefits.
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Affiliation(s)
- Penda Johm
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia; The Vaccine Centre, Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicole Nkoum
- Social Sciences and Health Division, Institute for Health Research, Epidemiological Surveillance and Training, IRESSEF, Diamniadio, Senegal
| | - Amie Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - El Hadji Mbaye
- Social Sciences and Health Division, Institute for Health Research, Epidemiological Surveillance and Training, IRESSEF, Diamniadio, Senegal
| | - Heidi Larson
- Vaccine Confidence Project, Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia; The Vaccine Centre, Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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24
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Safari D, Gultom SM, Tafroji W, Azzahidah A, Soesanti F, Khoeri MM, Prayitno A, Pimenta FC, da Gloria Carvalho M, Uiterwaal CSPM, Putri ND. Prevalence, serotype and antibiotic susceptibility of Group B Streptococcus isolated from pregnant women in Jakarta, Indonesia. PLoS One 2021; 16:e0252328. [PMID: 34043711 PMCID: PMC8158947 DOI: 10.1371/journal.pone.0252328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/13/2021] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS) is a bacterial pathogen which is a leading cause of neonatal infection. Currently, there are limited GBS data available from the Indonesian population. In this study, GBS colonization, serotype distribution and antimicrobial susceptibility profile of isolates were investigated among pregnant women in Jakarta, Indonesia. Demographics data, clinical characteristics and vaginal swabs were collected from 177 pregnant women (mean aged: 28.7 years old) at 29–40 weeks of gestation. Bacterial culture identification tests and latex agglutination were performed for GBS. Serotyping was done by conventional multiplex PCR and antibiotic susceptibility testing by broth microdilution. GBS colonization was found in 53 (30%) pregnant women. Serotype II was the most common serotype (30%) followed by serotype III (23%), Ia and IV (13% each), VI (8%), Ib and V (6% each), and one non-typeable strain. All isolates were susceptible to vancomycin, penicillin, ampicillin, cefotaxime, daptomycin and linezolid. The majority of GBS were resistant to tetracycline (89%) followed by clindamycin (21%), erythromycin (19%), and levofloxacin (6%). The serotype III was more resistant to erythromycin, clindamycin, and levofloxacin and these isolates were more likely to be multidrug resistant (6 out of 10) compared to other serotypes. This report provides demographics of GBS colonization and isolate characterization in pregnant women in Indonesia. The results may facilitate preventive strategies to reduce neonatal GBS infection and improve its treatment.
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Affiliation(s)
- Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Septiani Madonna Gultom
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wisnu Tafroji
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | - Frida Soesanti
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Ari Prayitno
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Fabiana C. Pimenta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, Julius Global Health, University Medical Center, Utrecht, the Netherlands
| | - Nina Dwi Putri
- Faculty of Medicine, Department of Child Health, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- * E-mail:
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25
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Development and Validation of Enzyme-Linked Immunosorbent Assay for Group B Streptococcal Polysaccharide Vaccine. Vaccines (Basel) 2021; 9:vaccines9060545. [PMID: 34064299 PMCID: PMC8224333 DOI: 10.3390/vaccines9060545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) is a leading cause of neonatal sepsis and meningitis in infants. Limitations of prenatal GBS screening and intrapartum antibiotic prophylaxis render developing GBS vaccines a high priority. In this study, we developed an enzyme-linked immunosorbent assay (ELISA) for the practical and large-scale evaluation of GBS capsular polysaccharide (PS) vaccine immunogenicity against three main serotypes, Ia, III, and V. GBS-ELISA was developed and subsequently validated using a standardized curve-fitting four-parameter logistic method. Specificity was measured using adsorption of serum with homologous and heterologous PS. Homologous adsorption showed a ≥75% inhibition of all three serotypes, whereas with heterologous PS, IgG GBS-ELISA inhibited only ≤25% of serotypes III and V. However, with serotype Ia, IgG antibody levels decreased by >50%, even after adsorption with heterologous PS (III or V). In comparison, the inhibition opsonophagocytic killing assay (OPA) of serotypes Ia GBS exhibited a reduction in opsonophagocytic activity of only 20% and 1.1% for serotypes III and V GBS, respectively. The precision of the GBS-ELISA was assessed in five independent experiments using four serum samples. The coefficient of variation was <5% for all three serotypes. This standardized GBS-ELISA would be useful for GBS vaccine development and its evaluation.
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26
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Bedeley E, Gori A, Yeboah-Manu D, Diallo K. Control of Streptococcal Infections: Is a Common Vaccine Target Achievable Against Streptococcus agalactiae and Streptococcus pneumoniae. Front Microbiol 2021; 12:658824. [PMID: 33967998 PMCID: PMC8103614 DOI: 10.3389/fmicb.2021.658824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
Both Streptococcus agalactiae [group B streptococcus (GBS)] and Streptococcus pneumoniae (pneumococcus) remain significant pathogens as they cause life threatening infections mostly in children and the elderly. The control of diseases caused by these pathogens is dependent on antibiotics use and appropriate vaccination. The introduction of the pneumococcal conjugate vaccines (PCVs) against some serotypes has led to reduction in pneumococcal infections, however, the subsequent serotype switching, and replacement has been a serious challenge. On the other hand, no vaccine is yet licensed for use in the control of GBS diseases. In this review, we provide an overview of the history and global disease burden, disease pathophysiology and management, vaccines update, and the biology of both pathogens. Furthermore, we address recent findings regarding structural similarities that could be explored for vaccine targets across both mucosal pathogens. Finally, we conclude by proposing future genomic sequence comparison using the wealth of available sequences from both species and the possibility of identifying more related structural components that could be exploited for pan-pathogen vaccine development.
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Affiliation(s)
- Edmund Bedeley
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Andrea Gori
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
| | - Kanny Diallo
- West African Centre for Cell Biology of Infectious Pathogens, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana
- Centre Suisse de Recherche Scientifique de Côte d’Ivoire, Abidjan, Côte d’Ivoire
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27
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Horváth-Puhó E, van Kassel MN, Gonçalves BP, de Gier B, Procter SR, Paul P, van der Ende A, Søgaard KK, Hahné SJM, Chandna J, Schrag SJ, van de Beek D, Jit M, Sørensen HT, Bijlsma MW, Lawn JE. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:398-407. [PMID: 33894156 PMCID: PMC8131199 DOI: 10.1016/s2352-4642(21)00022-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
Background Group B Streptococcus (GBS) disease is a leading cause of neonatal death, but its long-term effects have not been studied after early childhood. The aim of this study was to assess long-term mortality, neurodevelopmental impairments (NDIs), and economic outcomes after infant invasive GBS (iGBS) disease up to adolescence in Denmark and the Netherlands. Methods For this cohort study, children with iGBS disease were identified in Denmark and the Netherlands using national medical and administrative databases and culture results that confirmed their diagnoses. Exposed children were defined as having a history of iGBS disease (sepsis, meningitis, or pneumonia) by the age of 89 days. For each exposed child, ten unexposed children were randomly selected and matched by sex, year and month of birth, and gestational age. Mortality data were analysed with the use of Cox proportional hazards models. NDI data up to adolescence were captured from discharge diagnoses in the National Patient Registry (Denmark) and special educational support records (the Netherlands). Health care use and household income were also compared between the exposed and unexposed cohorts. Findings 2258 children—1561 in Denmark (born from Jan 1, 1997 to Dec 31, 2017) and 697 in the Netherlands (born from Jan 1, 2000 to Dec 31, 2017)—were identified to have iGBS disease and followed up for a median of 14 years (IQR 7–18) in Denmark and 9 years (6–11) in the Netherlands. 366 children had meningitis, 1763 had sepsis, and 129 had pneumonia (in Denmark only). These children were matched with 22 462 children with no history of iGBS disease. iGBS meningitis was associated with an increased mortality at age 5 years (adjusted hazard ratio 4·08 [95% CI 1·78–9·35] for Denmark and 6·73 [3·76–12·06] for the Netherlands). Any iGBS disease was associated with an increased risk of NDI at 10 years of age, both in Denmark (risk ratio 1·77 [95% CI 1·44–2·18]) and the Netherlands (2·28 [1·64–3·17]). A history of iGBS disease was associated with more frequent outpatient clinic visits (incidence rate ratio 1·93 [95% CI 1·79–2·09], p<0·0001) and hospital admissions (1·33 [1·27–1·38], p<0·0001) in children 5 years or younger. No differences in household income were observed between the exposed and unexposed cohorts. Interpretation iGBS disease, especially meningitis, was associated with increased mortality and a higher risk of NDIs in later childhood. This previously unquantified burden underlines the case for a maternal GBS vaccine, and the need to track and provide care for affected survivors of iGBS disease. Funding The Bill & Melinda Gates Foundation. Translations For the Dutch and Danish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Simon R Procter
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arie van der Ende
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; The National Institute for Public Health and the Environment, University of Amsterdam, Amsterdam, Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam, Netherlands
| | - Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Jit
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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28
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Alderson MR, Welsch JA, Regan K, Newhouse L, Bhat N, Marfin AA. Vaccines to Prevent Meningitis: Historical Perspectives and Future Directions. Microorganisms 2021; 9:microorganisms9040771. [PMID: 33917003 PMCID: PMC8067733 DOI: 10.3390/microorganisms9040771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 12/20/2022] Open
Abstract
Despite advances in the development and introduction of vaccines against the major bacterial causes of meningitis, the disease and its long-term after-effects remain a problem globally. The Global Roadmap to Defeat Meningitis by 2030 aims to accelerate progress through visionary and strategic goals that place a major emphasis on preventing meningitis via vaccination. Global vaccination against Haemophilus influenzae type B (Hib) is the most advanced, such that successful and low-cost combination vaccines incorporating Hib are broadly available. More affordable pneumococcal conjugate vaccines are becoming increasingly available, although countries ineligible for donor support still face access challenges and global serotype coverage is incomplete with existing licensed vaccines. Meningococcal disease control in Africa has progressed with the successful deployment of a low-cost serogroup A conjugate vaccine, but other serogroups still cause outbreaks in regions of the world where broadly protective and affordable vaccines have not been introduced into routine immunization programs. Progress has lagged for prevention of neonatal meningitis and although maternal vaccination against the leading cause, group B streptococcus (GBS), has progressed into clinical trials, no GBS vaccine has thus far reached Phase 3 evaluation. This article examines current and future efforts to control meningitis through vaccination.
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29
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Zhang D, Xu S, Wang Y, Zhu G. The Potentials of Melatonin in the Prevention and Treatment of Bacterial Meningitis Disease. Molecules 2021; 26:1419. [PMID: 33808027 PMCID: PMC7961363 DOI: 10.3390/molecules26051419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 02/08/2023] Open
Abstract
Bacterial meningitis (BM) is an acute infectious central nervous system (CNS) disease worldwide, occurring with 50% of the survivors left with a long-term serious sequela. Acute bacterial meningitis is more prevalent in resource-poor than resource-rich areas. The pathogenesis of BM involves complex mechanisms that are related to bacterial survival and multiplication in the bloodstream, increased permeability of blood-brain barrier (BBB), oxidative stress, and excessive inflammatory response in CNS. Considering drug-resistant bacteria increases the difficulty of meningitis treatment and the vaccine also has been limited to several serotypes, and the morbidity rate of BM still is very high. With recent development in neurology, there is promising progress for drug supplements of effectively preventing and treating BM. Several in vivo and in vitro studies have elaborated on understanding the significant mechanism of melatonin on BM. Melatonin is mainly secreted in the pineal gland and can cross the BBB. Melatonin and its metabolite have been reported as effective antioxidants and anti-inflammation, which are potentially useful as prevention and treatment therapy of BM. In bacterial meningitis, melatonin can play multiple protection effects in BM through various mechanisms, including immune response, antibacterial ability, the protection of BBB integrity, free radical scavenging, anti-inflammation, signaling pathways, and gut microbiome. This manuscript summarizes the major neuroprotective mechanisms of melatonin and explores the potential prevention and treatment approaches aimed at reducing morbidity and alleviating nerve injury of BM.
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Affiliation(s)
- Dong Zhang
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Shu Xu
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Yiting Wang
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
| | - Guoqiang Zhu
- College of Veterinary Medicine, Yangzhou University, Yangzhou 225009, China; (D.Z.); (S.X.); (Y.W.)
- Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou 225009, China
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30
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Pollard AJ, Bijker EM. A guide to vaccinology: from basic principles to new developments. Nat Rev Immunol 2020; 21:83-100. [PMID: 33353987 PMCID: PMC7754704 DOI: 10.1038/s41577-020-00479-7] [Citation(s) in RCA: 620] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
Immunization is a cornerstone of public health policy and is demonstrably highly cost-effective when used to protect child health. Although it could be argued that immunology has not thus far contributed much to vaccine development, in that most of the vaccines we use today were developed and tested empirically, it is clear that there are major challenges ahead to develop new vaccines for difficult-to-target pathogens, for which we urgently need a better understanding of protective immunity. Moreover, recognition of the huge potential and challenges for vaccines to control disease outbreaks and protect the older population, together with the availability of an array of new technologies, make it the perfect time for immunologists to be involved in designing the next generation of powerful immunogens. This Review provides an introductory overview of vaccines, immunization and related issues and thereby aims to inform a broad scientific audience about the underlying immunological concepts. This Review, aimed at a broad scientific audience, provides an introductory guide to the history, development and immunological basis of vaccines, immunization and related issues to provide insight into the challenges facing immunologists who are designing the next generation of vaccines.
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Affiliation(s)
- Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK. .,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK.
| | - Else M Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
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31
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Maternal Microbiome and Infections in Pregnancy. Microorganisms 2020; 8:microorganisms8121996. [PMID: 33333813 PMCID: PMC7765218 DOI: 10.3390/microorganisms8121996] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 12/14/2022] Open
Abstract
Pregnancy induces unique changes in maternal immune responses and metabolism. Drastic physiologic adaptations, in an intricately coordinated fashion, allow the maternal body to support the healthy growth of the fetus. The gut microbiome plays a central role in the regulation of the immune system, metabolism, and resistance to infections. Studies have reported changes in the maternal microbiome in the gut, vagina, and oral cavity during pregnancy; it remains unclear whether/how these changes might be related to maternal immune responses, metabolism, and susceptibility to infections during pregnancy. Our understanding of the concerted adaption of these different aspects of the human physiology to promote a successful pregnant remains limited. Here, we provide a comprehensive documentation and discussion of changes in the maternal microbiome in the gut, oral cavity, and vagina during pregnancy, metabolic changes and complications in the mother and newborn that may be, in part, driven by maternal gut dysbiosis, and, lastly, common infections in pregnancy. This review aims to shed light on how dysregulation of the maternal microbiome may underlie obstetrical metabolic complications and infections.
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32
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Rodgers E, Bentley SD, Borrow R, Bratcher HB, Brisse S, Brueggemann AB, Caugant DA, Findlow J, Fox L, Glennie L, Harrison LH, Harrison OB, Heyderman RS, van Rensburg MJ, Jolley KA, Kwambana-Adams B, Ladhani S, LaForce M, Levin M, Lucidarme J, MacAlasdair N, Maclennan J, Maiden MCJ, Maynard-Smith L, Muzzi A, Oster P, Rodrigues CMC, Ronveaux O, Serino L, Smith V, van der Ende A, Vázquez J, Wang X, Yezli S, Stuart JM. The global meningitis genome partnership. J Infect 2020; 81:510-520. [PMID: 32615197 DOI: 10.1016/j.jinf.2020.06.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
Genomic surveillance of bacterial meningitis pathogens is essential for effective disease control globally, enabling identification of emerging and expanding strains and consequent public health interventions. While there has been a rise in the use of whole genome sequencing, this has been driven predominately by a subset of countries with adequate capacity and resources. Global capacity to participate in surveillance needs to be expanded, particularly in low and middle-income countries with high disease burdens. In light of this, the WHO-led collaboration, Defeating Meningitis by 2030 Global Roadmap, has called for the establishment of a Global Meningitis Genome Partnership that links resources for: N. meningitidis (Nm), S. pneumoniae (Sp), H. influenzae (Hi) and S. agalactiae (Sa) to improve worldwide co-ordination of strain identification and tracking. Existing platforms containing relevant genomes include: PubMLST: Nm (31,622), Sp (15,132), Hi (1935), Sa (9026); The Wellcome Sanger Institute: Nm (13,711), Sp (> 24,000), Sa (6200), Hi (1738); and BMGAP: Nm (8785), Hi (2030). A steering group is being established to coordinate the initiative and encourage high-quality data curation. Next steps include: developing guidelines on open-access sharing of genomic data; defining a core set of metadata; and facilitating development of user-friendly interfaces that represent publicly available data.
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Affiliation(s)
- Elizabeth Rodgers
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK.
| | - Stephen D Bentley
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Ray Borrow
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | | | - Sylvain Brisse
- Institut Pasteur, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Angela B Brueggemann
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Dominique A Caugant
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jamie Findlow
- Pfizer Limited, Walton Oaks, Dorking Road, Tadworth, Surrey KT20 7NS, UK
| | - LeAnne Fox
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Robert S Heyderman
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | | | - Keith A Jolley
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | - Brenda Kwambana-Adams
- NIHR Global Health Mucosal Pathogens Research Unit, Division of Infection & Immunity, University College London, London, UK
| | - Shamez Ladhani
- Public Health England, Immunisation and Countermeasures Division, 61 Colindale Avenue, London NW9 5EQ, UK; Paediatric Infectious Diseases Research Group (PIDRG), St. George's University of London, Cranmer Terrace, London SW17 0RE, UK
| | | | | | - Jay Lucidarme
- Public Health England, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ, UK
| | - Neil MacAlasdair
- Wellcome Sanger Institute, Parasites and microbes, Hinxton CB10 1SA, UK
| | - Jenny Maclennan
- Department of Zoology, University of Oxford, Oxford OX1 3SY, UK
| | | | | | | | | | | | | | | | - Vinny Smith
- Meningitis Research Foundation, Newminster House, 27-29 Newminster House, Baldwin Street, Bristol BS1 1LT, UK
| | - Arie van der Ende
- Department of Medical Microbiology and Infection Prevention, University of Amsterdam, Amsterdam UMC and, the Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, the Netherlands
| | | | - Xin Wang
- Meningitis and Vaccine Preventable Disease Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, United States
| | - Saber Yezli
- Ministry of Health, The Global Centre for Mass Gatherings Medicine, Riyadh, Saudi Arabia
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Steer PJ, Russell AB, Kochhar S, Cox P, Plumb J, Gopal Rao G. Group B streptococcal disease in the mother and newborn-A review. Eur J Obstet Gynecol Reprod Biol 2020; 252:526-533. [PMID: 32586597 PMCID: PMC7295463 DOI: 10.1016/j.ejogrb.2020.06.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 02/06/2023]
Abstract
Group B Streptococcus, a common commensal in the gut of humans and in the lower genital tract in women, remains an important cause of neonatal mortality and morbidity. The incidence of early onset disease has fallen markedly in countries that test women for carriage at 35-37 weeks of pregnancy and then offer intrapartum prophylaxis with penicillin during labour. Countries that do not test, but instead employ a risk factor approach, have not seen a similar fall. There are concerns about the effect on the neonatal microbiome of widespread use of antibiotic prophylaxis during labour, but so far the effects seem minor and temporary. Vaccination against GBS would be acceptable to most women and GBS vaccines are in the early stages of development. Tweetable abstract: Group B Strep is a key cause of infection, death and disability in young babies. Antibiotics given in labour remain the mainstay of prevention, until a vaccine is available.
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Affiliation(s)
- Philip J Steer
- Imperial College London, Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom.
| | | | - Sonali Kochhar
- Global Healthcare Consulting, India; Department of Global Health, University of Washington, Seattle, United States
| | - Philippa Cox
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, RH16 1UA, United Kingdom
| | - Gopal Gopal Rao
- London North West University Healthcare NHS Trust, Harrow, United Kingdom
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34
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Group B Streptococcus colonization rate and serotype distribution among pregnant women and their newborns at Adama Hospital Medical College, Ethiopia. Sci Rep 2020; 10:9301. [PMID: 32518331 PMCID: PMC7283305 DOI: 10.1038/s41598-020-66474-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/22/2020] [Indexed: 11/08/2022] Open
Abstract
Rectovaginal area of pregnant women can be colonized transiently with group B Streptococcus (GBS) without causing disease. The bacteria can be transmitted to the newborn before and during birth and cause early-onset neonatal disease. In this study, we aimed to determine the GBS colonization rate among pregnant women before delivery and their newborns and serotypes distribution of GBS. Two hundred-eighty pregnant women along with their newborns were screened for GBS colonization from June 2014 to October 2014 at Adama Hospital Medical College. Rectovaginal swabs from pregnant women before delivery and specimen from nasal area, external ear, umbilical cord and throat of newborns were collected and cultured. The serotyping of GBS was performed by using serotype-specific antisera. To collect sociodemographic and clinical data we employed a structured questionnaire. GBS colonization among pregnant women and their newborns were 13.2% 95% CI (8.9-17.5) and 7.4% 95% CI (4.6-10.6). Out of 37 GBS strains recovered from pregnant women, the prevalent serotypes were Ia 6(16.2%), Ib 8(21.6%), II 10(27%), III 3(8.1%), and V 8(21.6%). Out of 21 GBS strains recovered from newborns, prevalent serotypes were Ia 3(14.3%), Ib 6(28.6%), II 6(28.6%), III 4(19%), and V 1(4.8%). This study indicated the existence of primary risk factors for neonatal disease in Adama area. Serotype II was the common serotype detected in this study which is followed by serotype Ib, Ia, and V. As colonizing GBS serotypes could cause invasive disease among newborns, vaccine formulation which includes serotype II, Ia, V, Ib, and III can prevent of invasive disease caused by GBS in the study area.
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Antibiotic Resistance and Molecular Epidemiological Characteristics of Streptococcus agalactiae Isolated from Pregnant Women in Guangzhou, South China. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2020; 2020:1368942. [PMID: 32399123 PMCID: PMC7210523 DOI: 10.1155/2020/1368942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Accepted: 03/07/2020] [Indexed: 11/17/2022]
Abstract
Streptococcus agalactiae colonization in pregnant women can cause postpartum intrauterine infections and life-threatening neonatal infections. To formulate strategies for the prevention and treatment of S. agalactiae infections, we performed a comprehensive analysis of antibiotic resistance and a molecular-based epidemiological investigation of S. agalactiae in this study. Seventy-two S. agalactiae strains, collected from pregnant women, were subjected to antibiotic susceptibility tests; then, the screened erythromycin and clindamycin nonsusceptible isolates were used for macrolides and clindamycin resistance genes detection, respectively. Detection of resistance genes, serotyping, and determination of virulence genes were performed by polymerase chain reaction. The clonal relationships among the colonized strains were evaluated by multilocus sequence typing. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) mass peak analysis was performed to discriminate the specific sequence types (STs). In our study, 69.4% and 47.2% of the strains were nonsusceptible to erythromycin and clindamycin, respectively; the multidrug resistance rate was 66.7%. All erythromycin nonsusceptible strains harbored resistance genes, whereas only 52.9% of the clindamycin nonsusceptible strains possessed the linB gene. Erythromycin resistance was mainly mediated by the ermB or mefA/E genes. Four serotypes were identified, and the most common serotype was serotype III (52.8%), followed by Ib (22.2%), Ia (18.0%), and II (4.2%). All the strains were divided into 18 STs that were assigned to nine clonal complexes. Most of the major STs were distributed into specific serotypes, including ST19/serotype III, ST17/serotype III, ST485/serotype Ia, ST862/serotype III, and ST651/serotype III. Analysis of virulence genes yielded seven clusters, of which bca-cfb-scpB-lmb (61.6%) was the predominant virulence gene cluster. Among all ST strains distributed in this region, only the ST17 strains had a mass peak at 7620 Da. The outcomes of this study are beneficial for the epidemiological comparison of colonized S. agalactiae in different regions and may be helpful for developing the strategies for the prevention of S. agalactiae infection in Guangzhou. Furthermore, our results show that MALDI-TOF MS can be used for the rapid identification of the ST17 strains.
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Carreras-Abad C, Ramkhelawon L, Heath PT, Le Doare K. A Vaccine Against Group B Streptococcus: Recent Advances. Infect Drug Resist 2020; 13:1263-1272. [PMID: 32425562 PMCID: PMC7196769 DOI: 10.2147/idr.s203454] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
Group B streptococcus (GBS) causes a high burden of neonatal and infant disease globally. Implementing a vaccine for pregnant women is a promising strategy to prevent neonatal and infant GBS disease and has been identified as a priority by the World Health Organisation (WHO). GBS serotype-specific polysaccharide – protein conjugate vaccines are at advanced stages of development, but a large number of participants would be required to undertake Phase III clinical efficacy trials. Efforts are therefore currently focused on establishing serocorrelates of protection in natural immunity studies as an alternative pathway for licensure of a GBS vaccine, followed by Phase IV studies to evaluate safety and effectiveness. Protein vaccines are in earlier stages of development but are highly promising as they might confer protection irrespective of serotype. Further epidemiological, immunological and health economic studies are required to enable the vaccine to reach its target population as soon as possible.
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Affiliation(s)
- Clara Carreras-Abad
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK.,Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laxmee Ramkhelawon
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute for Infection and Immunity, St George's, University of London, London, UK.,Pathogen Immunity Group, Public Health England, Porton Down,UK.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
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37
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Rasmussen SA, Kancherla V, Conover E. Joint position statement on vaccines from the Society for Birth Defects Research and Prevention and the Organization of Teratology Information Specialists. Birth Defects Res 2020; 112:527-534. [PMID: 32270605 DOI: 10.1002/bdr2.1674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Sonja A Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, Florida, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth Conover
- Department of Genetic Medicine, Munroe Meyer Institute, University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
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38
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Ahmed N, Giorgakoudi K, Usuf E, Okomo U, Clarke E, Kampmann B, Le Doare K, Trotter C. Potential cost-effectiveness of a maternal Group B streptococcal vaccine in The Gambia. Vaccine 2020; 38:3096-3104. [PMID: 32147298 DOI: 10.1016/j.vaccine.2020.02.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/18/2020] [Accepted: 02/24/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To estimate neonatal health benefits and healthcare provider costs of a theoretical Group B streptococcal (GBS) hexavalent maternal vaccination programme in The Gambia, a low-income setting in West Africa. METHODS A static decision analytic cost-effectiveness model was developed from the healthcare provider perspective. Demographic data and acute care costs were available from studies in The Gambia undertaken in 2012-2015. Further model parameters were taken from United Nations and World Health Organisation sources, supplemented by data from a global systematic review of GBS and literature searches. As vaccine efficacy is not known, we simulated vaccine efficacy estimates of 50-90%. Costs are reported in US dollars. Cost-effectiveness thresholds of one (US$473, very cost effective) and three (US$1420, cost effective) times Gambian GDP were used. RESULTS Vaccination with a hexavalent vaccine would avert 24 GBS disease cases (55%) and 768 disability adjusted life years compared to current standard of care (no interventions to prevent GBS disease). At vaccine efficacy of 70%, the programme is cost-effective at a maximum vaccine price per dose of 12 US$ (2016 US$), and very cost-effective at a maximum of $3/dose. The total costs of vaccination at $12 is $1,056,962 for one annual cohort of Gambian pregnant women. One-way sensitivity analysis showed that GBS incidence was the most influential parameter on the cost effectiveness ratio. CONCLUSION The introduction of a hexavalent vaccine would considerably reduce the current burden of GBS disease in The Gambia but to be cost-effective, the vaccine price per dose would need to be $12/dose or less.
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Affiliation(s)
- N Ahmed
- Imperial College London, London, UK
| | - K Giorgakoudi
- School of Health Sciences, City, University of London, London, UK; NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust, Insititute of Cancer Research, London, UK
| | - E Usuf
- Medical Research Council Unit The Gambia (MRCG) @LSHTM, Fajara, Gambia
| | - U Okomo
- Medical Research Council Unit The Gambia (MRCG) @LSHTM, Fajara, Gambia
| | - E Clarke
- Medical Research Council Unit The Gambia (MRCG) @LSHTM, Fajara, Gambia
| | - B Kampmann
- Medical Research Council Unit The Gambia (MRCG) @LSHTM, Fajara, Gambia
| | - K Le Doare
- Medical Research Council Unit The Gambia (MRCG) @LSHTM, Fajara, Gambia; St George's University of London, London, UK; West African Global Health Alliance, Dakar, Senegal
| | - C Trotter
- University of Cambridge, Cambridge, UK.
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39
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Vekemans J, Moorthy V, Friede M, Alderson MR, Sobanjo-Ter Meulen A, Baker CJ, Heath PT, Madhi SA, Mehring-Le Doare K, Saha SK, Schrag S, Kaslow DC. Maternal immunization against Group B streptococcus: World Health Organization research and development technological roadmap and preferred product characteristics. Vaccine 2019; 37:7391-7393. [PMID: 29398277 PMCID: PMC6892248 DOI: 10.1016/j.vaccine.2017.09.087] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 01/08/2023]
Abstract
Group B streptococcus, found in the vagina or lower gastrointestinal tract of about 10-40% of women of reproductive age, is a leading cause of early life invasive bacterial disease, potentially amenable to prevention through maternal immunization during pregnancy. Following a consultation process with global stakeholders, the World Health Organization is herein proposing priority research and development pathways and preferred product characteristics for GBS vaccines, with the aim to facilitate and accelerate vaccine licensure, policy recommendation for wide scale use and implementation.
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Affiliation(s)
| | | | | | | | | | | | - Paul T Heath
- Vaccine Institute, St Georges, University of London, London, UK
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Samir K Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Institute of Child Health, Dhaka, Bangladesh
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40
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Choi MJ, Noh JY, Jang AY, Cheong HJ, Kim WJ, Song DJ, Cho GJ, Oh MJ, Zhi Y, Seo HS, Song JY. Age-stratified analysis of serotype-specific baseline immunity against group B streptococcus. Hum Vaccin Immunother 2019; 16:1338-1344. [PMID: 31687869 DOI: 10.1080/21645515.2019.1688036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Group B streptococcus (GBS) vaccines are currently under development. Data on the natural immunity in diverse age groups will aid establishing the GBS immunization policy. In this study, thirty serum samples were collected from three age groups (neonates/infants, pregnant women, and the elderly) between August 2016 and July 2017. Serotype-specific opsonophagocytic activity (OPA) was assessed using a GBS multiplex opsonophagocytic killing assay (MOPA) against serotypes Ia, III, and V. The mean OPA titers for serotype Ia of the three age groups were not significantly different (p = .156), but tended to be lower in neonates/infants (mean ± standard deviation, 137 ± 278). For serotype III and V, the mean OPA titer of neonates/infants (338 ± 623 and 161 ± 445, respectively) was significantly lower than that of pregnant women (1377 ± 1167 and 9414 ± 6394) and the elderly (1350 ± 1741 and 3669 ± 5597) (p = .002). In conclusion, the lower levels of OPA titers against all tested serotypes in neonates/infants, despite high maternal titers, indicates that intrapartum GBS vaccinations may be required for efficient placental transfer of serotype-specific GBS antibodies with high avidity.
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Affiliation(s)
- Min Joo Choi
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine , Incheon, Korea
| | - Ji Yun Noh
- Department of Internal Medicine, Korea University College of Medicine , Seoul, Republic of Korea
| | - A-Yeung Jang
- Department of Internal Medicine, Korea University College of Medicine , Seoul, Republic of Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University College of Medicine , Seoul, Republic of Korea
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University College of Medicine , Seoul, Republic of Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine , Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Min Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Yong Zhi
- Biotechnology Division, Korea Atomic Energy Research Institute , Jeongeup, Republic of Korea.,Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology , Daejeon, Republic of Korea
| | - Ho Seong Seo
- Biotechnology Division, Korea Atomic Energy Research Institute , Jeongeup, Republic of Korea.,Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology , Daejeon, Republic of Korea
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine , Seoul, Republic of Korea
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41
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Ji W, Liu H, Madhi SA, Cunnington M, Zhang Z, Dangor Z, Zhou H, Mu X, Jin Z, Wang A, Qin X, Gao C, Zhu Y, Feng X, She S, Yang S, Liu J, Lei J, Jiang L, Liu Z, Li G, Li Q, Deng Q, Gao K, Fang Y. Clinical and Molecular Epidemiology of Invasive Group B Streptococcus Disease among Infants, China. Emerg Infect Dis 2019; 25:2021-2030. [PMID: 31600132 PMCID: PMC6810193 DOI: 10.3201/eid2511.181647] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Invasive group B Streptococcus (GBS) remains a leading cause of illness and death among infants globally. We conducted prospective and retrospective laboratory-based surveillance of GBS-positive cultures from infants <3 months of age in 18 hospitals across China during January 1, 2015-December 31, 2017. The overall incidence of GBS was 0.31 (95% CI 0.27-0.36) cases/1,000 live births; incidence was 0-0.76 cases/1,000 live births across participating hospitals. The case-fatality rate was 2.3%. We estimated 13,604 cases of GBS and 1,142 GBS-associated deaths in infants <90 days of age annually in China. GBS isolates were most commonly serotype III (61.5%) and clonal complex 17 (40.6%). Enhanced active surveillance and implementation of preventive strategies, such as maternal GBS vaccination, warrants further investigation in China to help prevent these infections.
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Affiliation(s)
| | | | - Shabir A. Madhi
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Marianne Cunnington
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zilu Zhang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Ziyaad Dangor
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Haijian Zhou
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaoping Mu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zhengjiang Jin
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Aimin Wang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaosong Qin
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Chunyan Gao
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Yuning Zhu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Xiaodan Feng
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Shangyang She
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Shuhua Yang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Jing Liu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Jine Lei
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Lan Jiang
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Zeshi Liu
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Gang Li
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Qiuhong Li
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Qiulian Deng
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
| | - Kankan Gao
- Xi’an Jiaotong University, Xi’an, China (W. Ji, Y. Fang)
- Guangzhou Medical University, Guangzhou, China (H. Liu, Q. Deng, K. Gao)
- University of the Witwatersrand, Johannesburg, South Africa (S.A. Madhi, Z. Dangor)
- GlaxoSmithKline Plc, London, UK (M. Cunnington)
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA (Z. Zhang)
- Chinese Center for Disease Control and Prevention, Beijing, China (H. Zhou)
- Guangzhou Medical University, Guangzhou (X. Mu)
- Hubei Maternal and Child Health Hospital, Wuhan, China (Z. Jin)
- Children’s Hospital of Fudan University, Shanghai, China (A. Wang)
- China Medical University, Shenyang, China (X. Qin)
- Tangshan Maternal and Child Health Care Hospital, Tangshan, China (C. Gao)
- Zhejiang University, Hangzhou, China (Y. Zhu)
- Nanjing Maternity and Child Health Care Hospital, Nanjing, China (X. Feng)
- Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanjing (S. She)
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China (S. Yang)
- Tsinghua University Hospital, Beijing (J. Liu)
- The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an (J. Lei)
- Maternal and Child Health Care Hospital of Uygur Autonomous Region, Urumqi, China (L. Jiang)
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an (Z. Liu)
- General Hospital of Ningxia Medical University, Yinchuan, China (G. Li)
- Chongqing Health Center for Women and Children, Chongqing, China (Q. Li)
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Li J, Ji W, Gao K, Zhou H, Zhang L, Mu X, Yuan C, Guan X, Deng Q, Zhang L, Zhong H, Gao X, Gao F, Long Y, Chang CY, McIver DJ, Liu H. Molecular characteristics of group B Streptococcus isolates from infants in southern mainland China. BMC Infect Dis 2019; 19:812. [PMID: 31533652 PMCID: PMC6751900 DOI: 10.1186/s12879-019-4434-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/30/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive group B Streptococcus (GBS) disease in Chinese infants has gradually gained attention in recent years, but the molecular epidemiology of the pathogen is still not well known. METHODS This multicenter study retrospectively investigated distribution of capsular serotypes, sequence types (STs), and hypervirulent GBS adhesin gene (hvgA) in clinical GBS isolates that caused invasive disease in infants aged < 3 months of age in southern mainland China between January 2013 and June 2016. Genes for antibiotic resistance to tetracycline, erythromycin, and clindamycin were also examined. RESULTS From a total of 93 GBS isolates taken from 34 early-onset disease (EOD, 0-6 days after birth) and 59 late-onset disease (LOD, 7-89 days after birth) cases, four serotypes were identified: serotypes III (79.6%), Ib (12.9%), Ia (4.3%), and V (3.2%). Serotype III accounted for 73.5% of EOD and 83.1% of LOD and was responsible for 75.5% of cases involving meningitis. Fifteen STs were found, with the majority being ST17 (61.3%), ST12 (7.5%), ST19 (7.5%), and others (23.7%). 96.8% of STs belonged to only five clonal complexes (CCs): CC17 (64.5%), CC10 (12.9%), CC19 (9.7%), CC23 (6.5%), and CC1 (3.2%). The hvgA gene was detected in 66.7% of GBS isolates and 95% of CC17 isolates, all of which were serotype III except one serotype Ib/CC17 isolate. A large proportion of GBS isolates were found to be resistant to tetracycline (93.5%), clindamycin (65.5%), and erythromycin (60.2%). Genes of tetO (74.7%) and tetM (46.0%) were found in tetracycline resistant isolates, linB (24.6%) in clindamycin resistant isolates, and ermB (87.5%) and mefA (3.6%) in erythromycin resistant isolates. CONCLUSION Our results reveal higher prevalence of serotype III, ST17, CC17, hvgA expressing, and antibiotic resistant GBS isolates than previously reported in southern mainland China. This study provides guidance for appropriate measures of prevention and control to be taken in the future.
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Affiliation(s)
- Juan Li
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
- Clinical Laboratory, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095 Guangdong China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, 710049 Shaanxi China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, 710049 Shaanxi China
| | - Kankan Gao
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Haijian Zhou
- National Institute for Communicable Disease Control and Prevention, and State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, Beijing, 102206 China
| | - Lihua Zhang
- Clinical Laboratory, Dongguan Tungwah Hospital, Sun Yat-Sen Universtiy, Dongguan, 523110 Guangdong China
| | - Xiaoping Mu
- Clinical Laboratory, Guangdong Women and Children’s Hospital, Guangzhou, 511400 Guangdong China
| | - Chunlei Yuan
- Clinical Laboratory, ZhongshanBoai Hospital, Zhongshan, 528403 Guangdong China
| | - Xiaoshan Guan
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Qiulian Deng
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Lian Zhang
- Department of Neonatalogy, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong China
| | - Huamin Zhong
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Xiurong Gao
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Fei Gao
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Yan Long
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
| | - Chien-Yi Chang
- School of Chemistry and Biosceinces, University of Bradford, Bradford, UK
| | | | - Haiying Liu
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510623 Guangdong China
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Gendrin C, Merillat S, Vornhagen J, Coleman M, Armistead B, Ngo L, Aggarwal A, Quach P, Berrigan J, Rajagopal L. Diminished Capsule Exacerbates Virulence, Blood-Brain Barrier Penetration, Intracellular Persistence, and Antibiotic Evasion of Hyperhemolytic Group B Streptococci. J Infect Dis 2019; 217:1128-1138. [PMID: 29301010 DOI: 10.1093/infdis/jix684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/28/2017] [Indexed: 12/21/2022] Open
Abstract
Group B streptococci (GBS) are encapsulated, β-hemolytic bacteria that are a common cause of infections in human newborns and certain adults. Two factors important for GBS virulence are the sialic acid capsular polysaccharide that promotes immune evasion and the hemolytic pigment that induces host cell cytotoxcity. These virulence factors are often oppositely regulated by the CovR/CovS two-component system. Clinical GBS strains exhibiting hyperhemolysis and low capsule due to pathoadaptive covR/S mutations have been isolated from patients. Given the importance of capsule to GBS virulence, we predicted that a decrease or loss of capsule would attenuate the virulence of covR/S mutants. Surprisingly, hyperhemolytic GBS with low or no capsule exhibit increased virulence, intracellular persistence, and blood-brain barrier penetration, which was independent of a Trojan horse mechanism of barrier penetration. Additionally, intracellular persistence enabled both hemolytic and hyperhemolytic GBS to evade antibiotics routinely used to treat these infections. The finding that diminished capsule expression promotes GBS virulence, intracellular persistence, and antibiotic evasion has important implications for sustained antibiotic therapy and efficacy of capsule-based vaccines.
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Affiliation(s)
- Claire Gendrin
- Department of Pediatrics, University of Washington.,Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Sean Merillat
- Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Jay Vornhagen
- Department of Pediatrics, University of Washington.,Center for Global Infections Disease Research, Seattle Children's Research Institute.,Department of Global Health, University of Washington, Seattle
| | - Michelle Coleman
- Department of Pediatrics, University of Washington.,Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Blair Armistead
- Department of Pediatrics, University of Washington.,Center for Global Infections Disease Research, Seattle Children's Research Institute.,Department of Global Health, University of Washington, Seattle
| | - Lisa Ngo
- Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Anjali Aggarwal
- Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Phoenicia Quach
- Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Jacob Berrigan
- Center for Global Infections Disease Research, Seattle Children's Research Institute
| | - Lakshmi Rajagopal
- Department of Pediatrics, University of Washington.,Center for Global Infections Disease Research, Seattle Children's Research Institute.,Department of Global Health, University of Washington, Seattle
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44
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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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45
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Francois Watkins LK, McGee L, Schrag SJ, Beall B, Jain JH, Pondo T, Farley MM, Harrison LH, Zansky SM, Baumbach J, Lynfield R, Snippes Vagnone P, Miller LA, Schaffner W, Thomas AR, Watt JP, Petit S, Langley GE. Epidemiology of Invasive Group B Streptococcal Infections Among Nonpregnant Adults in the United States, 2008-2016. JAMA Intern Med 2019; 179:479-488. [PMID: 30776079 PMCID: PMC6450309 DOI: 10.1001/jamainternmed.2018.7269] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022]
Abstract
Importance Group B Streptococcus (GBS) is an important cause of invasive bacterial disease. Previous studies have shown a substantial and increasing burden of GBS infections among nonpregnant adults, particularly older adults and those with underlying medical conditions. Objective To update trends of invasive GBS disease among US adults using population-based surveillance data. Design, Setting, and Participants In this population-based surveillance study, a case was defined as isolation of GBS from a sterile site between January 1, 2008, and December 31, 2016. Demographic and clinical data were abstracted from medical records. Rates were calculated using US Census data. Antimicrobial susceptibility testing and serotyping were performed on a subset of isolates. Case patients were residents of 1 of 10 catchment areas of the Active Bacterial Core surveillance (ABCs) network, representing approximately 11.5% of the US adult population. Patients were included in the study if they were nonpregnant, were 18 years or older, were residents of an ABCs catchment site, and had a positive GBS culture from a normally sterile body site. Main Outcomes and Measures Trends in GBS cases overall and by demographic characteristics (sex, age, and race), underlying clinical conditions of patients, and isolate characteristics are described. Results The ABCs network detected 21 250 patients with invasive GBS among nonpregnant adults from 2008 through 2016. The GBS incidence in this population increased from 8.1 cases per 100 000 population in 2008 to 10.9 in 2016 (P = .002 for trend). There were 3146 cases reported in 2016 (59% male; median age, 64 years; age range, 18-103 years). The GBS incidence was higher among men than women and among blacks than whites and increased with age. Projected to the US population, an estimated 27 729 cases of invasive disease and 1541 deaths occurred in the United States in 2016. Ninety-five percent of cases in 2016 occurred in someone with at least 1 underlying condition, most commonly obesity (53.9%) and diabetes (53.4%). Resistance to clindamycin increased from 37.0% of isolates in 2011 to 43.2% in 2016 (P = .02). Serotypes Ia, Ib, II, III, and V accounted for 86.4% of isolates in 2016; serotype IV increased from 4.7% in 2008 to 11.3% in 2016 (P < .001 for trend). Conclusions and Relevance The public health burden of invasive GBS disease among nonpregnant adults is substantial and continues to increase. Chronic diseases, such as obesity and diabetes, may contribute.
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Affiliation(s)
- Louise K. Francois Watkins
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hudson Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica M. Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Lisa A. Miller
- Colorado School of Public Health, University of Colorado Denver, Aurora
- Colorado Department of Public Health and Environment, Denver
| | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Gayle E. Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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46
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Lin SM, Jang AY, Zhi Y, Gao S, Lim S, Lim JH, Song JY, Sullam PM, Rhee JH, Seo HS. Vaccination With a Latch Peptide Provides Serotype-Independent Protection Against Group B Streptococcus Infection in Mice. J Infect Dis 2019; 217:93-102. [PMID: 29106586 DOI: 10.1093/infdis/jix565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/24/2017] [Indexed: 11/14/2022] Open
Abstract
Streptococcus agalactiae (group B streptococcus [GBS]) is a leading cause of invasive diseases in neonates and severe infections in elderly individuals. GBS serine-rich repeat glycoprotein 1 (Srr1) acts as a critical virulence factor by facilitating GBS invasion into the central nervous system through interaction with the fibrinogen Aα chain. This study revealed that srr1 is highly conserved, with 86.7% of GBS clinical isolates expressing the protein. Vaccination of mice with different Srr1 truncated peptides revealed that only Srr1 truncates containing the latch domain protected against GBS meningitis. Furthermore, the latch peptide alone was immunogenic and elicited protective antibodies, which efficiently enhanced antibody-mediated opsonophagocytic killing of GBS by HL60 cells and provided heterogeneous protection against 4 different GBS serogroups. Taken together, these findings indicated that the latch domain of Srr1 may constitute an effective peptide vaccine candidate for GBS.
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Affiliation(s)
- Shun-Mei Lin
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Brain Korea 21 Program for Leading Universities and Students, Department of Molecular Medicine, Chonnam National University Medical School, Gwangju
| | - A-Yeung Jang
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Department of Biological Sciences, Chonbuk National University, Jeonju
| | - Yong Zhi
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon
| | - Shuang Gao
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Brain Korea 21 Program for Leading Universities and Students, Department of Molecular Medicine, Chonnam National University Medical School, Gwangju
| | - Sangyong Lim
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon
| | - Jae Hyang Lim
- Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon
| | - Joon Young Song
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Paul M Sullam
- Department of Microbiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.,Division of Infectious Diseases, Veterans Affairs Medical Center, University of California-San Francisco, San Francisco, California.,Department of Medicine, University of California-San Francisco, San Francisco, California.,Northern California Institute for Research and Education, San Francisco, California
| | - Joon Haeng Rhee
- Brain Korea 21 Program for Leading Universities and Students, Department of Molecular Medicine, Chonnam National University Medical School, Gwangju.,Department of Microbiology, Chonnam National University Medical School, Gwangju.,Clinical Vaccine Research and Development Center, Chonnam National University Medical School, Gwangju
| | - Ho Seong Seo
- Biotechnology Division, Korea Atomic Energy Research Institute, Jeongeup.,Department of Radiation Biotechnology and Applied Radioisotope Science, University of Science and Technology, Daejeon
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47
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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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48
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Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, Lynfield R, Vagnone PS, Burzlaff K, Spina NL, Dufort EM, Schaffner W, Thomas AR, Farley MM, Jain JH, Pondo T, McGee L, Beall BW, Schrag SJ. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr 2019; 173:224-233. [PMID: 30640366 PMCID: PMC6439883 DOI: 10.1001/jamapediatrics.2018.4826] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development. OBJECTIVE To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development. DESIGN, SETTING, AND PARTICIPANTS This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018. EXPOSURES Group B Streptococcus isolated from a normally sterile site. MAIN OUTCOMES AND MEASURES Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance. RESULTS The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally. CONCLUSIONS AND RELEVANCE The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention.
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Affiliation(s)
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Chad Smelser
- New Mexico Department of Public Health, Santa Fe
| | | | - Nisha B. Alden
- Colorado Department of Public Health and Environment, Denver
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Monica M. Farley
- Emory University School of Medicine, Atlanta, Georgia,Atlanta VA Medical Center, Atlanta, Georgia
| | - Jennifer H. Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard W. Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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49
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Serocorrelates of protection against infant group B streptococcus disease. THE LANCET. INFECTIOUS DISEASES 2019; 19:e162-e171. [PMID: 30683467 DOI: 10.1016/s1473-3099(18)30659-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/20/2018] [Accepted: 10/24/2018] [Indexed: 12/12/2022]
Abstract
Group B streptococcus (GBS) is a leading cause of young infant mortality and morbidity globally, with vaccines being developed for over four decades but none licensed to date. A serocorrelate of protection against invasive disease in young infants is being considered to facilitate vaccine early licensure, followed by demonstration of efficacy assessed postlicensure. In this Review, we synthesise the available scientific evidence to define an immune correlate associated with GBS disease risk reduction on the basis of studies of natural infection. We summarise studies that have investigated GBS serum anticapsular or anti-protein antibodies, and studies measuring the association between antibody function and disease risk reduction. We highlight how knowledge on the development of correlates of protection from existing vaccines could be harnessed to facilitate GBS vaccine development. These lessons include aggregation of serocorrelates of protection for individual serotypes, understanding the relationship between immunity derived from natural exposure of adults and vaccine-induced immunity, or using extrapolation of protection from in-vitro immunoassay results. We also highlight key considerations for the assessment of the role of antibodies to derive a serocorrelate of risk reduction in future seroepidemiological studies of GBS disease.
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Schrag SJ. Group B streptococcal disease: unmet needs in high-income countries. THE LANCET. INFECTIOUS DISEASES 2019; 19:8-10. [PMID: 30497954 DOI: 10.1016/s1473-3099(18)30604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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