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Le Doare K, Gaylord MA, Anderson AS, Andrews N, Baker CJ, Bolcen S, Felek A, Giardina PC, Grube CD, Hall T, Hallis B, Izu A, Madhi SA, Maniatis P, Matheson M, Mawas F, McKeen A, Rhodes J, Alston B, Patel P, Schrag S, Simon R, Tan CY, Taylor S, Kwatra G, Gorringe A. Interlaboratory comparison of a multiplex immunoassay that measures human serum IgG antibodies against six-group B streptococcus polysaccharides. Hum Vaccin Immunother 2024; 20:2330138. [PMID: 38608170 PMCID: PMC11018077 DOI: 10.1080/21645515.2024.2330138] [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: 11/30/2023] [Accepted: 03/09/2024] [Indexed: 04/14/2024] Open
Abstract
Measurement of IgG antibodies against group B streptococcus (GBS) capsular polysaccharide (CPS) by use of a standardized and internationally accepted multiplex immunoassay is important for the evaluation of candidate maternal GBS vaccines in order to compare results across studies. A standardized assay is also required if serocorrelates of protection against invasive GBS disease are to be established in infant sera for the six predominant GBS serotypes since it would permit the comparison of results across the six serotypes. We undertook an interlaboratory study across five laboratories that used standardized assay reagents and protocols with a panel of 44 human sera to measure IgG antibodies against GBS CPS serotypes Ia, Ib, II, III, IV, and V. The within-laboratory intermediate precision, which included factors like the lot of coated beads, laboratory analyst, and day, was generally below 20% relative standard deviation (RSD) for all six serotypes, across all five laboratories. The cross-laboratory reproducibility was < 25% RSD for all six serotypes, which demonstrated the consistency of results across the different laboratories. Additionally, anti-CPS IgG concentrations for the 44-member human serum panel were established. The results of this study showed assay robustness and that the resultant anti-CPS IgG concentrations were reproducible across laboratories for the six GBS CPS serotypes when the standardized assay was used.
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Affiliation(s)
- Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London, UK
- Makerere University Johns Hopkins University, Kampala, Uganda
- UK Health Security Agency, Porton Down, UK
| | | | | | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Carol J. Baker
- Department of Pediatrics, Division of Infectious Disease, McGovern Medical School and UT Health, Houston, TX, USA
| | - Shanna Bolcen
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Arif Felek
- Vaccine Division, Scientific Research & Innovation Group, MHRA, Potters Bar, UK
| | | | | | - Tom Hall
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | | | - Alane Izu
- 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 Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, 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
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Pete Maniatis
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Fatme Mawas
- Vaccine Division, Scientific Research & Innovation Group, MHRA, Potters Bar, UK
| | - Andrew McKeen
- Pfizer Global Biometrics & Data Management, Pearl River, NY, USA
| | - Julia Rhodes
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Palak Patel
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Stephanie Schrag
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Raphael Simon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - Charles Y. Tan
- Pfizer Global Biometrics & Data Management, Pearl River, NY, USA
| | | | - 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 Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Gaylord MA, Larrier M, Giordano-Schmidt D, Grube CD, Singh S, Nguyen HH, McKeen A, Tan CY, Anderson AS, Kalina WV, Pavliakova D, Giardina PC. Development and validation of a 6-plex Luminex-based assay for measuring human serum antibodies to group B streptococcus capsular polysaccharides. Hum Vaccin Immunother 2024; 20:2311480. [PMID: 38608171 PMCID: PMC11018021 DOI: 10.1080/21645515.2024.2311480] [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: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 04/14/2024] Open
Abstract
Six serotypes (Ia, Ib, II, III, IV, and V) cause nearly all group B streptococcal (GBS) disease globally. Capsular polysaccharide (CPS) conjugate vaccines aim to prevent GBS disease, however, licensure of a vaccine would depend on a standardized serological assay for measuring anti-CPS IgG responses. A multiplex direct Luminex-based immunoassay (dLIA) has been developed to simultaneously measure the concentration of serum IgG specific for the six prevalent GBS CPS serotypes. Assay validation was performed using serum samples obtained from human subjects vaccinated with an investigational 6-valent GBS CPS conjugate vaccine. Results for the assay are expressed as IgG concentrations (µg/mL) using a human serum reference standard composed of pooled sera from vaccinated subjects. The lower limits of quantitation (LLOQ) for all serotypes covered in the 6-plex GBS IgG dLIA fell within the range of 0.002-0.022 µg/mL IgG. Taken together, the 6-plex GBS IgG dLIA platform is specific for the six GBS serotypes included in Pfizer's investigational vaccine, has a wide dilution adjusted assay range, and is precise (<18.5% relative standard deviation) for all serotypes, and, therefore, is suitable for quantitatively measuring vaccine-induced or naturally acquired serotype-specific anti-CPS IgG responses against GBS.
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Affiliation(s)
| | - Melissa Larrier
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | | | | | - Suddham Singh
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Ha H. Nguyen
- Global Biometrics & Data Management, Pfizer Inc, Pearl River, New York, USA
| | - Andrew McKeen
- Global Biometrics & Data Management, Pfizer Inc, Pearl River, New York, USA
| | - Charles Y. Tan
- Global Biometrics & Data Management, Pfizer Inc, Collegeville, PA, USA
| | | | - Warren V. Kalina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Danka Pavliakova
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
| | - Peter C. Giardina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York, USA
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Al Aamri R, Al Yazidi L, Al Hashami H, Al Jabri A, Al Haddabi R, Al Adawi B. Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study. Pediatr Infect Dis J 2024; 43:942-945. [PMID: 38808975 DOI: 10.1097/inf.0000000000004412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes. METHODS We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018. RESULTS Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4-0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5-0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), ( P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%. CONCLUSIONS The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.
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Affiliation(s)
- Rajaa Al Aamri
- From the Department of Microbiology, Nizwa Hospital, Nizwa
| | - Laila Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Sultan Qaboos University
- Paediatric Department, Oman Medical Speciality Board
| | - Hilal Al Hashami
- Paediatric Department, Oman Medical Speciality Board
- Paediatric Infectious Disease Unit, The Royal Hospital
| | - Amal Al Jabri
- Paediatric Department, Oman Medical Speciality Board
- Department of Infection Prevention and Control, Khoula Hospital, Muscat
| | | | - Badriya Al Adawi
- Paediatric Department, Oman Medical Speciality Board
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat, Oman
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Khan K. Neurodevelopmental impairment associated with neonatal invasive group B Streptococcus disease: Are animal models on track in understanding the mechanisms at play? Brain Behav Immun Health 2024; 40:100831. [PMID: 39144833 PMCID: PMC11320442 DOI: 10.1016/j.bbih.2024.100831] [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: 11/28/2023] [Revised: 06/23/2024] [Accepted: 07/20/2024] [Indexed: 08/16/2024] Open
Abstract
Invasive Group B Streptococcus (iGBS) disease is a prominent cause of neurodevelopmental impairment (NDI) in neonates. While the clinical manifestation of iGBS disease in neonates may include pneumonia and meningitis, generalised sepsis without focus is the most frequent manifestation of iGBS disease in neonates. Though recent human based studies highlighted meningitis as an important manifestation in infants with NDI following iGBS disease, they also noted that ∼18% of neonates present with NDI following iGBS related sepsis. Thus, it is important to not only understand the long-term pathophysiological changes associated with NDI in iGBS meningitis survivors, but so too for iGBS sepsis survivors. Since the late 1970's animal models have been used to unravel the pathophysiology of neonatal iGBS disease. These studies have inoculated neonatal or pregnant animals with GBS via various peripheral or central routes. The greatest challenge with using animal models to study NDI associated with neonatal iGBS disease, is effectively mimicking the clinical presentations of pneumonia, sepsis, and meningitis, while inducing relevant pathophysiological changes and ensuring animals survival, so as to test the neurodevelopment of the animals. This review aims to evaluate the validity of neonatal rodent models, specifically in studying NDI associated with neonatal iGBS disease and explore possible future avenues of research in addressing long-term NDI in the clinical setting.
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Affiliation(s)
- Khaalid Khan
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Imperi M, Gherardi G, Alfarone G, Creti R. Group B Streptococcus Infections in Non-Pregnant Adults, Italy, 2015-2019. Pathogens 2024; 13:807. [PMID: 39338998 DOI: 10.3390/pathogens13090807] [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: 07/15/2024] [Revised: 08/29/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a pathogen of increasing importance in adults. Severe and invasive cases in non-pregnant adults were collected during the period 2015-2019 by voluntary-based surveillance. In total, 108 GBS strains were phenotypically and genotypically characterized for the serotype, antimicrobial resistance, pili, surface protein genes, and the hyper-virulent adhesin hvgA. Patients were divided into two age groups: adults (18-64 years; n = 32) and older adults (≥65 years; n = 72). The average age was 70.8 years, with a male/female ratio of 1.7. Most isolates were recovered from cases of bacteremia (blood, n = 93), and a higher frequency of invasive GBS infections (iGBS) was found among older adults (66.7%). Serotype III was the most frequent (n = 41, 38%), followed by type Ia and type V (n = 20 each, 18.5%). Serotypes Ia, Ib, II, III, IV, and V accounted for all but one isolates (99.1%). The iGBS isolates were universally susceptible to penicillin, while the prevalence of resistance to clindamycin, erythromycin, tetracycline, and high-level gentamicin resistance was 26.8%, 24.1%, 85.2%, and 5.5%, respectively, with the predominance of the erm(B) gene for macrolide resistance and the tet(M) gene for tetracycline resistance. The associations between the serotypes/antimicrobial resistance/virulence traits underlined the increasing importance of serotype III and its contribution to antimicrobial resistance as well as the steady increase over time of serotype IV. This nationwide study confirmed the need for monitoring the GBS epidemiology in non-pregnant adults through continuous surveillance of GBS infections.
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Affiliation(s)
- Monica Imperi
- Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giovanni Gherardi
- Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giovanna Alfarone
- Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Roberta Creti
- Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanità, 00161 Rome, Italy
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Lohrmann F, Efstratiou A, Sørensen UBS, Creti R, Decheva A, Křížová P, Kozáková J, Rodriguez-Granger J, De La Rosa Fraile M, Margarit I, Rinaudo D, Maione D, Telford J, Orefici G, Kilian M, Afshar B, Melin P, Berner R, Hufnagel M, Kunze M. Maternal Streptococcus agalactiae colonization in Europe: data from the multi-center DEVANI study. Infection 2024:10.1007/s15010-024-02380-0. [PMID: 39244714 DOI: 10.1007/s15010-024-02380-0] [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: 07/24/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION Despite national guidelines and use of intrapartum antibiotic prophylaxis (IAP), Streptococcus agalactiae (group B streptococci (GBS)) is still a leading cause of morbidity and mortality in newborns in Europe and the United States. The European DEVANI (Design of a Vaccine Against Neonatal Infections) program assessed the neonatal GBS infection burden in Europe, the clinical characteristics of colonized women and microbiological data of GBS strains in colonized women and their infants with early-onset disease (EOD). METHODS Overall, 1083 pregnant women with a GBS-positive culture result from eight European countries were included in the study. Clinical obstetrical information was collected by a standardized questionnaire. GBS strains were characterized by serological and molecular methods. RESULTS Among GBS carriers included in this study after testing positive for GBS by vaginal or recto-vaginal sampling, 13.4% had at least one additional obstetrical risk factor for EOD. The five most common capsular types (i.e., Ia, Ib, II, III and V) comprised ~ 93% of GBS carried. Of the colonized women, 77.8% received any IAP, and in 49.5% the IAP was considered appropriate. In our cohort, nine neonates presented with GBS early-onset disease (EOD) with significant regional heterogeneity. CONCLUSIONS Screening methods and IAP rates need to be harmonized across Europe in order to reduce the rates of EOD. The epidemiological data from eight different European countries provides important information for the development of a successful GBS vaccine.
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Affiliation(s)
- Florens Lohrmann
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | | | | | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Antoaneta Decheva
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Pavla Křížová
- National Institute of Public Health, Prague, Czech Republic
| | - Jana Kozáková
- National Institute of Public Health, Prague, Czech Republic
| | | | | | | | | | | | | | - Graziella Orefici
- Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Mogens Kilian
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Pierrette Melin
- Department of Clinical Microbiology, National Reference Center Streptococcus Agalactiae, University Hospital Center of Liege, Liege, Belgium
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Obstetrics and Gynecology, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany.
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Gong X, Jin Y, Han X, Jiang X, Miao B, Meng S, Zhang J, Zhou H, Zheng H, Feng J, Li J. Genomic characterization and resistance features of Streptococcus agalactiae isolated from non-pregnant adults in Shandong, China. J Glob Antimicrob Resist 2024; 38:146-153. [PMID: 38866137 DOI: 10.1016/j.jgar.2024.06.001] [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: 01/17/2024] [Revised: 05/04/2024] [Accepted: 06/01/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Streptococcus agalactiae is a recognized pathogen that primarily affects infants and pregnant women. However, its increasingly important role in causing invasive infections among non-pregnant adults has become a significant health concern due to the severity and variety of its clinical impacts. METHODS Nonduplicate S. agalactiae clinical strains associated with clinical infections (n = 139) were isolated from non-pregnant adults in Shandong, China. Antibiotic susceptibility testing, whole-genome sequencing and genomic analyses were conducted to characterize the genome and identify resistance features of these strains. RESULTS The strains exhibited universal susceptibility to penicillin, ampicillin, cefotaxime, meropenem, linezolid and vancomycin. Notably, high resistance rates were observed for erythromycin (91.4%), clindamycin (89.2%), levofloxacin (84.2%), tetracycline (54.0%) and, to a lesser extent, chloramphenicol (12.9%). Serotyping revealed seven serotypes and one non-typeable strain. Serotypes Ia, Ib, III and V predominated, representing 95.7% of the strains. Nineteen sequence types were categorized into seven clonal complexes, with CC10 being the most prevalent at 48.9%. The resistance genes mreA (100%), ermB (70.5%) and tetM (46.0%) were commonly detected. All the isolates carried at least one pilus backbone determinant and one alpha-like protein gene, with the PI-1+PI-2a and the bca gene being the most frequent at 84.2% and 54.7%, respectively. CONCLUSIONS While S. agalactiae strains in non-pregnant adults retain sensitivity to β-lactam antibiotics, the elevated resistance to erythromycin, clindamycin, levofloxacin and tetracycline is concerning. Given the growing elderly population worldwide, the burden of S. agalactiae infections is significant. Continuous surveillance of serotype distribution and antibiotic resistance patterns is imperative for targeted prevention and therapeutic strategies.
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Affiliation(s)
- Xinyi Gong
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Jin
- Clinical Laboratories of Shandong Provincial Hospital, Jinan, Shandong, China
| | - Xiao Han
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xueqi Jiang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Beibei Miao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shuang Meng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingyi Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haijian Zhou
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Han Zheng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Feng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Juan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Disease, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Chen J, Mou L, Wang L, Wu G, Dai X, Chen Q, Zhang J, Luo X, Xu F, Zhang M, Duan Y, Pang H, Wang Y, Cai Y, Tan Z. Mixed Bacillus subtilis and Lactiplantibacillus plantarum-fermented feed improves gut microbiota and immunity of Bamei piglet. Front Microbiol 2024; 15:1442373. [PMID: 39268530 PMCID: PMC11390403 DOI: 10.3389/fmicb.2024.1442373] [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: 06/03/2024] [Accepted: 08/02/2024] [Indexed: 09/15/2024] Open
Abstract
Antibiotics are widely used in the breeding production of Bamei pigs, affecting the quality and safety of pork and causing enormous harm to human health, the environment, and public health. The use of probiotic fermented feed to replace antibiotic feed is one of the solutions, which has the potential to improve the intestinal microbiota, promote animal growth, and enhance immunity. The purpose of this study was to evaluate the effect of fermented feed with Lactiplantibacillus (L.) plantarum QP28-1a or Bacillus (B.) subtilis QB8a on feed, growth performance, gut microbiota, and immunity of weaned piglets. A total of 60 freshly weaned piglets from the Tibetan Plateau were randomly divided into five groups and fed basal feed, L. plantarum fermented feed, B. subtilis fermented feed, mixed fermented feed, and antibiotic fermented feed for 60 days, respectively. The results showed fermented feed supplemented with L. plantarum QP28-1a or B. subtilis QB8a significantly lowered the pH of the feed (P < 0.05), produced lactic acid and acetic acid, inhibited the growth of harmful bacteria in the feed, and reduced the feed conversion rate in the group fed mixed fermented feed (P < 0.05). The fermented feed increased the α-diversity and prominently altered the β-diversity of the intestinal microbiota, increasing the relative abundance of beneficial bacteria such as Lactobacillus and Turicibacter and decreasing the relative abundance of conditional pathogens such as Streptococcus and Clostridium, improving the intestinal microbiota of the Bamei piglets. Notably, the mixed fermented feed improved the immunity of Bamei piglets by modulating the production of pro-inflammatory cytokines, anti-inflammatory cytokines, and inflammatory-related signaling pathways. Spearman's correlation analysis revealed that the increased expression of immune-related cytokines may be associated with a significant enrichment of Lactobacillus, Prevotellaceae, Erysipelotrichaceae, and Ruminococcaceae in the gut. In conclusion, the probiotic fermented feed maintained an acidic environment conducive to suppressing pathogens, reduced the feed conversion ratio, optimized the intestinal microbiota, improved immunity, and alleviated intestinal inflammation that may be caused by weaning, demonstrating the excellent application prospects of L. plantarum QP28-1a and B. subtilis QB8a fermented feed in the feeding of Bamei piglets.
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Affiliation(s)
- Jun Chen
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Liyu Mou
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Lei Wang
- Plateau Livestock Genetic Resources Protection and Innovative Utilization Key Laboratory of Qinghai Province, Key Laboratory of Animal Genetics and Breeding on Tibetan Plateau, Ministry of Agriculture and Rural Affairs, Qinghai Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, China
| | - Guofang Wu
- Plateau Livestock Genetic Resources Protection and Innovative Utilization Key Laboratory of Qinghai Province, Key Laboratory of Animal Genetics and Breeding on Tibetan Plateau, Ministry of Agriculture and Rural Affairs, Qinghai Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, China
| | - Ximei Dai
- Laboratory of Zhongyuan Light, School of Physics, Zhengzhou University, Zhengzhou, China
| | - Qiufang Chen
- Laboratory of Zhongyuan Light, School of Physics, Zhengzhou University, Zhengzhou, China
| | - Jianbo Zhang
- Plateau Livestock Genetic Resources Protection and Innovative Utilization Key Laboratory of Qinghai Province, Key Laboratory of Animal Genetics and Breeding on Tibetan Plateau, Ministry of Agriculture and Rural Affairs, Qinghai Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, China
| | - Xuan Luo
- Plateau Livestock Genetic Resources Protection and Innovative Utilization Key Laboratory of Qinghai Province, Key Laboratory of Animal Genetics and Breeding on Tibetan Plateau, Ministry of Agriculture and Rural Affairs, Qinghai Academy of Animal Science and Veterinary Medicine, Qinghai University, Xining, China
| | - Fafang Xu
- Bamei Pig Original Breeding Base of Huzhu County, Huzhou, China
| | - Miao Zhang
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Yaoke Duan
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Huili Pang
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Yanping Wang
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Yimin Cai
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
| | - Zhongfang Tan
- Henan Key Laboratory of Ion-Beam Green Agriculture Bioengineering, School of Agricultural Sciences, Zhengzhou University, Zhengzhou, China
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Kwatra G, Izu A, Cutland C, Akaba G, Ali MM, Ahmed Z, Beck MM, Barsosio HC, Berkley JA, Chaka TE, Cossa A, Chakraborty S, Dhar N, Dorji P, Islam M, Keita AM, Mwakio S, Mwarumba S, Medugu N, Mucavele H, Mabombo V, Obaro S, Sigaúque B, Sow SO, Saha SK, Santhanam S, Sharma R, Simoes EAF, Sahni RD, Tapia MD, Veeraraghavan B, Madhi SA. Prevalence of group B Streptococcus colonisation in mother-newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study. THE LANCET. MICROBE 2024:100897. [PMID: 39178870 DOI: 10.1016/s2666-5247(24)00129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Rectovaginal group B Streptococcus (GBS) colonisation in pregnant individuals at the time of labour is a major risk factor for invasive GBS disease by age 7 days (early-onset disease). We aimed to investigate the prevalence of rectovaginal GBS colonisation at the time of labour among pregnant women and vertical transmission to their newborns across selected low-income and middle-income African and south Asian countries. METHODS This prospective, observational study was undertaken at 11 maternity and obstetric care facilities based in Ethiopia, Kenya, Mozambique, Nigeria, Mali, South Africa, Bangladesh, India, and Bhutan. HIV-negative pregnant women aged 18-45 years who were in the early stages of labour and at least 37 weeks' gestation were eligible for inclusion. Lower vaginal and rectal swabs and urine were collected from the women, and swabs of the umbilicus, outer ear, axillary fold, rectum, and throat were obtained from their newborns, for GBS culture. Standardised sampling and culture using direct plating and selective media broth for detection of GBS colonisation was undertaken at the sites. Serotyping of GBS isolates was done in South Africa. The primary outcome was the prevalence of rectovaginal GBS among pregnant women, analysed in participants with available data. This study is registered with the South African National Clinical Trials Register, number DOH-27-0418-4989. FINDINGS 6922 pregnant women were enrolled from Jan 10, 2016, to Dec 11, 2018, of whom 6514 (94·1%; 759-892 per country) were included in the analysis; data from Bhutan were not included in the study due to issues with specimen collection and processing. Overall, the prevalence of maternal GBS colonisation was 24·1% (95% CI 23·1-25·2; 1572 of 6514); it was highest in Mali (41·1% [37·7-44·6]; 314 of 764) and lowest in Ethiopia (11·6% [9·5-14·1]; 88 of 759). The overall rate of vertical transmission of GBS from women with rectovaginal GBS colonisation was 72·3% (70·0-74·4; 1132 of 1566); it was highest in Mozambique (79·2% [73·3-84·2]; 168 of 212) and lowest in Bangladesh (55·8%, 47·5-63·8; 77 of 138). The five most common GBS colonising serotypes were Ia (37·3% [34·9-39·7]; 586 of 1572), V (28·5% [26·3-30·8]; 448 of 1572), III (25·1% [23·0-27·3]; 394 of 1572), II (9·2% [7·8-10·7]; 144 of 1572), and Ib (6·5% [5·4-7·8]; 102 of 1572). There was geographical variability in serotype proportion distribution; serotype VII was the third most common serotype in India (8·6% [5·3-13·7]; 15 of 174) and serotype VI was mainly identified in Bangladesh (5·8% [3·0-11·0]; eight of 138) and India (5·7% [3·2-10·3]; ten of 174). INTERPRETATION Our study reported a high prevalence of GBS colonisation in most settings, with some geographical variability even within African countries. Our findings suggest that serotypes not included in current multivalent capsular-polysaccharide GBS vaccines prevail in some regions, so vaccine efficacy and post-licensure effectiveness studies should assess the effect of vaccination on maternal GBS colonisation given the potential for replacement by non-vaccine serotypes. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Alane Izu
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Cutland
- African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Godwin Akaba
- Department of Obstetrics and Gynaecology, The University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Musa Mohammed Ali
- Hawassa University College of Medicine and Health Sciences, School of Medical Laboratory Sciences, Hawassa, Ethiopia
| | - Zabed Ahmed
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | | | | | | | - Tolossa E Chaka
- Department of Pediatrics and Child Health, Adama Hospital Medical College, Adama City, Ethiopia
| | - Anélsio Cossa
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Sowmitra Chakraborty
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Nisha Dhar
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Phurb Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Maksuda Islam
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Adama Mamby Keita
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Stella Mwakio
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Nubwa Medugu
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria; Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria
| | - Helio Mucavele
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Viviana Mabombo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Stephen Obaro
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Betuel Sigaúque
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Samba O Sow
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, India
| | - Ragunath Sharma
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Eric A F Simoes
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
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10
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Crestani C, Forde TL, Bell J, Lycett SJ, Oliveira LMA, Pinto TCA, Cobo-Ángel CG, Ceballos-Márquez A, Phuoc NN, Sirimanapong W, Chen SL, Jamrozy D, Bentley SD, Fontaine M, Zadoks RN. Genomic and functional determinants of host spectrum in Group B Streptococcus. PLoS Pathog 2024; 20:e1012400. [PMID: 39133742 PMCID: PMC11341095 DOI: 10.1371/journal.ppat.1012400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/22/2024] [Accepted: 07/08/2024] [Indexed: 08/24/2024] Open
Abstract
Group B Streptococcus (GBS) is a major human and animal pathogen that threatens public health and food security. Spill-over and spill-back between host species is possible due to adaptation and amplification of GBS in new niches but the evolutionary and functional mechanisms underpinning those phenomena are poorly known. Based on analysis of 1,254 curated genomes from all major GBS host species and six continents, we found that the global GBS population comprises host-generalist, host-adapted and host-restricted sublineages, which are found across host groups, preferentially within one host group, or exclusively within one host group, respectively, and show distinct levels of recombination. Strikingly, the association of GBS genomes with the three major host groups (humans, cattle, fish) is driven by a single accessory gene cluster per host, regardless of sublineage or the breadth of host spectrum. Moreover, those gene clusters are shared with other streptococcal species occupying the same niche and are functionally relevant for host tropism. Our findings demonstrate (1) the heterogeneity of genome plasticity within a bacterial species of public health importance, enabling the identification of high-risk clones; (2) the contribution of inter-species gene transmission to the evolution of GBS; and (3) the importance of considering the role of animal hosts, and the accessory gene pool associated with their microbiota, in the evolution of multi-host bacterial pathogens. Collectively, these phenomena may explain the adaptation and clonal expansion of GBS in animal reservoirs and the risk of spill-over and spill-back between animals and humans.
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Affiliation(s)
- Chiara Crestani
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Taya L. Forde
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - John Bell
- Moredun Research Institute, Penicuik, Scotland, United Kingdom
| | - Samantha J. Lycett
- The Roslin Institute, University of Edinburgh, Midlothian, Scotland, United Kingdom
| | - Laura M. A. Oliveira
- Instituto de Microbiologia Paulo de Goes, Federal University of Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | - Tatiana C. A. Pinto
- Instituto de Microbiologia Paulo de Goes, Federal University of Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
| | | | | | - Nguyen N. Phuoc
- Faculty of Fisheries, University of Agriculture and Forestry, Hue University, Hue, Vietnam
| | - Wanna Sirimanapong
- Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Swaine L. Chen
- Infectious Diseases Translational Research Programme, Department of Medicine, Division of Infectious Diseases, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Laboratory of Bacterial Genomics, Genome Institute of Singapore, Singapore
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, England, United Kingdom
| | - Stephen D. Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, England, United Kingdom
| | | | - Ruth N. Zadoks
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, Scotland, United Kingdom
- Moredun Research Institute, Penicuik, Scotland, United Kingdom
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Camden, NSW, Australia
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11
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Akbari MS, Joyce LR, Spencer BL, McIver KS, Doran KS. Identification of Glyoxalase A in Group B Streptococcus and its contribution to methylglyoxal tolerance and virulence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.30.605887. [PMID: 39131367 PMCID: PMC11312555 DOI: 10.1101/2024.07.30.605887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Group B Streptococcus (GBS) is a Gram-positive pathobiont that commonly colonizes the gastrointestinal and lower female genital tracts but can cause sepsis and pneumonia in newborns and is a leading cause of neonatal meningitis. Despite the resulting disease severity, the pathogenesis of GBS is not completely understood, especially during the early phases of infection. To investigate GBS factors necessary for blood stream survival, we performed a transposon (Tn) mutant screen in our bacteremia infection model using a GBS mariner transposon mutant library previously developed by our group. We identified significantly underrepresented mutations in 628 genes that contribute to survival in the blood, including those encoding known virulence factors such as capsule, the β-hemolysin, and inorganic metal ion transport systems. Most of the underrepresented genes have not been previously characterized or studied in GBS, including gloA and gloB, which are homologs for genes involved in methylglyoxal (MG) detoxification. MG is a byproduct of glycolysis and a highly reactive toxic aldehyde that is elevated in immune cells during infection. Here, we observed MG sensitivity across multiple GBS isolates and confirm that gloA contributes to MG tolerance and invasive GBS infection. We show specifically that gloA contributes to GBS survival in the presence of neutrophils and depleting neutrophils in mice abrogates the decreased survival and infection of the gloA mutant. The requirement of the glyoxalase pathway during GBS infection suggests that MG detoxification is important for bacterial survival during host-pathogen interactions.
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Affiliation(s)
- Madeline S. Akbari
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado USA
| | - Luke R. Joyce
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado USA
| | - Brady L. Spencer
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado USA
| | - Kevin S. McIver
- Cell Biology and Molecular Genetics, Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland, USA
| | - Kelly S. Doran
- Department of Immunology and Microbiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado USA
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12
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Choi JH, Kim TH, Kim ET, Kim YR, Lee H. Molecular epidemiology and virulence factors of group B Streptococcus in South Korea according to the invasiveness. BMC Infect Dis 2024; 24:740. [PMID: 39060964 PMCID: PMC11282841 DOI: 10.1186/s12879-024-09625-1] [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: 05/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) causes invasive infections in newborns and elderly individuals, but is a noninvasive commensal bacterium in most immunocompetent people. Recently, the incidence of invasive GBS infections has increased worldwide, and there is growing interest in the molecular genetic characteristics of invasive GBS strains. Vaccines against GBS are expected in the near future. Here, we aimed to analyze the molecular epidemiology of GBS according to the invasiveness in South Korea. METHODS We analyzed GBS isolates collected and stored in two hospitals in South Korea between January 2015 and December 2020. The invasiveness of these isolates was determined via a retrospective review of clinical episodes. Totally, 120 GBS isolates from 55 children and 65 adults were analyzed. Serotype and sequence type (ST) were determined using multiplex polymerase chain reaction (PCR) and multilocus sequence typing, respectively. Fourteen virulence factor-encoding genes of GBS were analyzed using multiplex PCR. RESULTS Forty one (34.2%) were invasive infection-related GBS isolates (iGBS). The most frequently detected serotype was III (39/120, 32.5%), and it accounted for a high proportion of iGBS (21/41, 51.2%). The most frequent ST was ST19 (18/120, 15.0%), followed by ST2 (17/120, 14.2%). Serotype III/ST17 was predominant in iGBS (12/41, 29.3%), and all 17 ST2 strains were noninvasive. The distribution of most of the investigated virulence factors was not significantly related to invasiveness; noteworthily, most of the serotype III/ST17 iGBS carried pilus island (PI) 2b (10/12, 83.3%), and the prevalence of fbsB was significantly low compared with noninvasive GBS isolates (P = 0.004). Characteristically, the combination of bca(+)-cspA(+)-pavA(+)-fbsB(-)-rib(+)-bac(-) was predominant in iGBS (24.4%, 10/41). CONCLUSIONS Serotype III/ST17 GBS carrying PI-2b was frequently detected in iGBS. There was no significant association between invasiveness and the pattern of virulence factors; however, a specific combination of virulence factors was predominant in iGBS.
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Affiliation(s)
- Jae Hong Choi
- Pediatrics, Jeju National University College of Medicine, Jeju, Republic of Korea
- Pediatrics, Jeju National University Hospital, Jeju, Republic of Korea
| | - Tae Hyoung Kim
- Biomedicine and Drug Development, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Eui Tae Kim
- Biomedicine and Drug Development, Jeju National University College of Medicine, Jeju, Republic of Korea
- Microbiology and Immunology, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Young Ree Kim
- Laboratory Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyunju Lee
- Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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13
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Saukkoriipi A, Silmon de Monerri NC, Toropainen M, Lindholm L, Veijola R, Toppari J, Knip M, Radley D, Gomme E, Jongihlati B, Anderson AS, Palmu AA, Simon R. Association between anti-capsular IgG levels at birth and risk of invasive group B streptococcus disease in Finnish newborns: a retrospective case-control study. THE LANCET. MICROBE 2024; 5:689-696. [PMID: 38679040 DOI: 10.1016/s2666-5247(24)00038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Group B streptococcus is a major cause of neonatal disease. Natural history studies have linked maternally transferred anti-group B streptococcus capsular polysaccharide antibodies with protection against infant group B streptococcus disease. Previous studies of capsular polysaccharide antibody concentration in European populations have used maternal (not infant) sera and a non-standardised assay. This study aimed to evaluate anti-capsular polysaccharide IgG concentrations associated with protection against invasive group B streptococcus disease in Finnish infants. METHODS In this retrospective case-control study, we used cord sera from the Finnish DIPP study repository, which was obtained between Jan 1, 1995, and Dec 31, 2017. We included infants aged 6 months or younger with group B streptococcus infection (cases) and healthy infants (controls). We enrolled infants with invasive neonatal group B streptococcus (55 cases) and matched controls (229 controls) aged 6 months or younger after identification from Finnish health registers. We measured anti-capsular polysaccharide IgG (serotypes Ia-V) concentration using a standardised immunoassay and we estimated its relationship to disease risk using a Bayesian model. We used the derived risk-concentration curve to predict potential efficacy of six-valent group B streptococcus capsular polysaccharide vaccine (GBS6) based on previously reported immunogenicity data. FINDINGS Most (32 [58%] of 55 cases) group B streptococcus cases were due to serotype III and anti-serotype III streptococcus capsular IgG concentrations were higher in serotype III-matched controls than in cases (p<0·001). 0·120-0·266 μg/mL serotype III-specific IgG was estimated to confer 75-90% risk reduction against serotype III disease. A universal risk-concentration curve, aggregating results across all six serotypes, yielded similar results. Application of this curve to GBS6 immunogenicity data predicted maternal immunisation to be more than 80% efficacious for prevention of infant group B streptococcus disease. INTERPRETATION Higher neonatal anti-capsular polysaccharide serum IgG concentration at birth correlated with reduced risk of infant group B streptococcus disease in Finland. Based on these results, a maternal group B streptococcus capsular conjugate vaccine currently in development is predicted to be efficacious. FUNDING Pfizer.
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Affiliation(s)
| | | | | | - Laura Lindholm
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Veijola
- Department of Pediatrics, Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrated Physiology and Pharmacology, Centre for Population Health Research, University of Turku, Turku, Finland; Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Mikael Knip
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland; Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David Radley
- Vaccine Research and Development, Pfizer, Pearl River, NY, USA
| | - Emily Gomme
- Vaccine Research and Development, Pfizer, Pearl River, NY, USA
| | | | | | - Arto A Palmu
- Finnish Institute for Health and Welfare, Tampere, Finland
| | - Raphael Simon
- Vaccine Research and Development, Pfizer, Pearl River, NY, USA.
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14
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Alemayehu T, Frigati L. Editorial: Perinatal infections among newborns in African countries: under-recognized, under-resourced and under-treated - a call for action. Front Public Health 2024; 12:1439757. [PMID: 38975358 PMCID: PMC11224513 DOI: 10.3389/fpubh.2024.1439757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Tinsae Alemayehu
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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15
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Ji W, Zhou H, Li J, Britto CD, Liu Z, Zhang W, Du J, Madhi SA, Kwatra G, Dangor Z, Jin Z, Zhao H, Zhao Y, Fang Y, Li J. Distributions of candidate vaccine Targets, virulence Factors, and resistance features of invasive group B Streptococcus using Whole-Genome Sequencing: A Multicenter, population-based surveillance study. Vaccine 2024; 42:3564-3571. [PMID: 38692955 DOI: 10.1016/j.vaccine.2024.04.062] [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: 09/19/2023] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Group B Streptococcus (GBS) is a leading cause of morbidity and mortality in young infants worldwide. This study aimed to investigate candidate GBS vaccine targets, virulence factors, and antimicrobial resistance determinants. METHODS We used whole-genome sequencing to characterize invasive GBS isolates from infants < 3 months of age obtained from a multicenter population-based study conducted from 2015 to 2021 in China. RESULTS Overall, seven serotypes were detected from 278 GBS isolates, four (Ia, Ib, III, V) of which accounted for 97.8 %. We detected 30 sequence types (including 10 novel types) that were grouped into six clonal complexes (CCs: CC1, CC10, CC17, CC19, CC23 and CC651); three novel ST groups in CC17 were detected, and the rate of CC17, considered a hyperinvasive neonatal clone complex, was attached to 40.6 % (113/278). A total of 98.9 % (275/278) of isolates harbored at least one alpha-like protein gene. All GBS isolates contained at least one of three pilus backbone determinants and the pilus types PI-2b and PI-1 + PI-2a accounted for 79.8 % of the isolates. The 112 serotype III/CC17 GBS isolates were all positive for hvgA. Most of the isolates (75.2 %) were positive for serine-rich repeat glycoprotein determinants (srr1or srr2). Almost all isolates possessed cfb (99.6 %), c1IE (100 %), lmb (95.3 %) or pavA (100 %) gene. Seventy-seven percent of isolates harboured more than three antimicrobial resistance genes with 28.4 % (79/278) gyrA quinoloneresistancedeterminants mutation, 83.8 % (233/278) carrying tet cluster genes and 77.3 % (215/278) carrying erm genes which mediated fluoroquinolone, tetracycline and clindamycin resistance, respectively." CONCLUSIONS The findings from this large whole-genome sequence of GBS isolates establish important baseline data required for further surveillance and evaluating the impact of future vaccine candidates.
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Affiliation(s)
- Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haijian Zhou
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carl D Britto
- Boston Children's Hospital, Boston, MA, United States
| | - Zheliang Liu
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; North China University of Science and Technology, China
| | - Wen Zhang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Ziyaad Dangor
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Faculty of Health Science, Johannesburg, South Africa
| | - Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yifei Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Juan Li
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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16
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Caballero Méndez A, Reynoso de la Rosa RA, Abreu Bencosme ME, Sosa Ortiz MN, Pichardo Beltré E, de la Cruz García DM, Piñero Santana NJ, Bacalhau de León JC. Development and performance evaluation of a qPCR-based assay for the fully automated detection of group B Streptococcus (GBS) on the Panther Fusion Open Access system. Microbiol Spectr 2024; 12:e0005724. [PMID: 38682931 PMCID: PMC11237499 DOI: 10.1128/spectrum.00057-24] [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: 01/09/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Streptococcus agalactiae [group B Streptococcus (GBS)] poses a major threat as the primary cause of early-onset neonatal invasive disease, particularly when mothers are colonized rectovaginally. Although culture remains the gold standard for antepartum GBS screening, quantitative polymerase chain reaction (qPCR) offers advantages in terms of sensitivity and turnaround time. The aim of this study was to validate the clinical utility of an automated qPCR laboratory-developed test (LDT) for antepartum GBS screening using the Panther Fusion Open Access system (Hologic, California, USA). The LDT targeted a conserved region of the GBS surface immunogenic protein gene, demonstrating no cross-reactivity and high coverage (99.82%-99.99%). The limit of detection (LoD) was 118 CFU/mL. Comparison with commercial qPCR assays (Panther Fusion GBS and VIASURE Streptococcus B Real-Time) revealed an overall agreement of 99.7%, with a robust Cohen's kappa coefficient of 0.992. Testing of 285 rectovaginal swabs from pregnant women and 15 external quality assessment samples demonstrated exceptional diagnostic performance of the LDT, achieving a diagnostic sensitivity and specificity of 100%, underscoring its accuracy. Prevalence and predictive values were also determined to reinforce test reliability. Our research highlights the limitations of culture-based screening and supports the suitability of our qPCR-based LDT for GBS detection in a clinical setting.IMPORTANCERectovaginal colonization by GBS is a major risk factor for early-onset invasive neonatal disease. The most effective approach to reducing the incidence of early-onset disease (EOD) has been described as universal screening, involving assessment of GBS colonization status in late pregnancy and intrapartum antibiotic prophylaxis. Despite its turnaround time and sensitivity limitations, culture remains the gold standard method for GBS screening. However, nucleic acid amplification-based tests, such as qPCR, have been utilized due to their speed and high sensitivity and specificity. This study validated the clinical usefulness of an automated qPCR-LDT for antepartum GBS screening through the Panther Fusion Open Access system (Hologic). Our study addresses the critical need for more robust, sensitive, and rapid strategies for GBS screening in pregnant women that could favorably impact the incidence of EOD.
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Affiliation(s)
- Andy Caballero Méndez
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Roberto A. Reynoso de la Rosa
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Miguel E. Abreu Bencosme
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Mayeline N. Sosa Ortiz
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Eliezel Pichardo Beltré
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Darah M. de la Cruz García
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Nelson J. Piñero Santana
- Molecular Biology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
| | - Joana C. Bacalhau de León
- Microbiology Department, Referencia Laboratorio Clínico, Santo Domingo Oeste, Santo Domingo, Dominican Republic
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Porzio S, Bianchi M. Adherence to universal screening for group B Streptococcus in pregnancy and prevalence of colonised pregnancies in Caserta province, Italy. LE INFEZIONI IN MEDICINA 2024; 32:213-221. [PMID: 38827839 PMCID: PMC11142412 DOI: 10.53854/liim-3202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/12/2024] [Indexed: 06/05/2024]
Abstract
Group B Streptococcus (Streptococcus agalactiae; GBS) infection is a significant contributor to neonatal morbidity and mortality. In the early 1970s, the neonatal mortality rate for infants with invasive GBS disease was 55%. With the adoption of the first medical community guidelines to prevent GBS infection in the 1990s, the mortality rate decreased to approximately 5%. The main obstetric procedure for preventing vertical transmission of GBS infection involves universal screening of pregnant women using a vaginal-rectal swab (VRS) to identify those eligible for intrapartum antibiotic prophylaxis (IAP). The study analyzes the adherence of screening and the trend of GBS infection in pregnancy in the province of Caserta, Italy. Data were obtained from pregnant women who gave birth in a first level birthing center in 2022 from birth assistance certificate (CEDAP), obstetric and neonatal record. Postnatal evaluation collected through computer-assisted telephone interviews. 567 women delivered at our center during the study period. The average coverage of GBS testing in pregnancy was 99.2% (562), and the proportion of GBS colonised women was 12.6% (71) according with the national average, which is about 10-20%. The spread of positive cases appears to fluctuate among the various groups of pregnant women studied, indicating no significant statistical variance among presence of a partner, among women who have given birth multiple times, among Italian nationals, or across different ages, but a significant statistical excess is evident among mothers with less education. In 93% (66) of GBS carrier mothers, intrapartum antibiotic prophylaxis (IAP) was administered correctly, regardless of the type of delivery performed. Despite the successful integration of GBS screening, a significant gap remains between the ideal scenario and the actual implementation of IAP. At the three-month assessment, no child required hospitalization, consistent with the relatively low incidence of invasive GBS infection. Nevertheless, for those who are not eligible to VRS screening, such as preterm birth, or IAP, as in precipitous birth, the identification of biomarkers enabling early recognition of invasive GBS disease remains essential. Additionally, the emergence of vaccines administered during gestation, conferring passive immunity to newborns represents a promising possible new direction. Therefore, to ensure the practical application of GBS screening and actual IAP by healthcare providers, periodic audits and regular monitoring should be encouraged.
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Affiliation(s)
- Salvatore Porzio
- Dipartimento Materno-infantile, Casa di Cura San Michele, Maddaloni (Caserta),
Italia
| | - Maurizio Bianchi
- Department of Translational Medical Science, University of Naples Federico II, Naples,
Italy
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Creti R, Imperi M, Khan UB, Berardi A, Recchia S, Alfarone G, Gherardi G. Emergence of High-Level Gentamicin Resistance in Streptococcus agalactiae Hypervirulent Serotype IV ST1010 (CC452) Strains by Acquisition of a Novel Integrative and Conjugative Element. Antibiotics (Basel) 2024; 13:491. [PMID: 38927158 PMCID: PMC11201010 DOI: 10.3390/antibiotics13060491] [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: 05/06/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Streptococcus agalactiae (group B streptococci, GBS) is responsible for severe infections in both neonates and adults. Currently, empiric antimicrobial therapy for sepsis and meningitis is the combined use of penicillin and gentamicin due to the enhanced bactericidal activity. However, high-level gentamicin resistance (HLGR) abrogates the synergism. The rate of HLGR was investigated within a dataset of 433 GBS strains collected from cases of invasive disease in both adults and neonates as well as from pregnant carriers. GBS isolates (n = 20, 4.6%) presented with HLGR (gentamicin MIC breakpoint >1024 mg/L) that was differently diffused between strains from adults or neonates (5.2% vs. 2.8%). Notably, 70% of HLGR GBS strains (14 isolates) were serotype IV. Serotype IV HLGR-GBS isolates were susceptible to all antibiotics tested, exhibited the alpha-C/HvgA/PI-2b virulence string, and belonged to sequence type 1010 (clonal complex (CC) 452). The mobile element that harbored the HLGR aac(6')-aph(2)″ gene is a novel integrative and conjugative element (ICE) about 45 kb long, derived from GBS 515 ICE tRNALys. The clonal expansion of this HLGR hypervirulent serotype IV GBS CC452 sublineage may pose a threat to the management of infections caused by this strain type.
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Affiliation(s)
- Roberta Creti
- Dipartimento di Malattie Infettive, Reparto di Antibiotico-Resistenza e Patogeni Speciali, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (S.R.); (G.A.); (G.G.)
| | - Monica Imperi
- Dipartimento di Malattie Infettive, Reparto di Antibiotico-Resistenza e Patogeni Speciali, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (S.R.); (G.A.); (G.G.)
| | - Uzma Basit Khan
- Parasites and Microbes Programme, The Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UK;
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Simona Recchia
- Dipartimento di Malattie Infettive, Reparto di Antibiotico-Resistenza e Patogeni Speciali, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (S.R.); (G.A.); (G.G.)
| | - Giovanna Alfarone
- Dipartimento di Malattie Infettive, Reparto di Antibiotico-Resistenza e Patogeni Speciali, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (S.R.); (G.A.); (G.G.)
| | - Giovanni Gherardi
- Dipartimento di Malattie Infettive, Reparto di Antibiotico-Resistenza e Patogeni Speciali, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (S.R.); (G.A.); (G.G.)
- Unità di Ricerca di Scienze Batteriologiche Applicate, Facoltà Dipartimentale di Medicina e Chirurgia, Università Campus Bio-Medico, 00128 Rome, Italy
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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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Oldendorff F, Nordberg V, Giske CG, Navér L. A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives. Eur J Clin Microbiol Infect Dis 2024; 43:959-968. [PMID: 38517573 PMCID: PMC11108929 DOI: 10.1007/s10096-024-04809-8] [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: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. METHODS A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. RESULTS We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. CONCLUSION GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.
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Affiliation(s)
- Frida Oldendorff
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
| | - Viveka Nordberg
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
- Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Navér
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
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21
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Delettre N, Billion E, Guyonnet C, Jarreau PH, Patkaï J, Tazi A. Outbreak of group B Streptococcus in a neonatal care unit confirmed by whole-genome sequencing. Acta Paediatr 2024; 113:947-954. [PMID: 38183311 DOI: 10.1111/apa.17095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
AIM Clusters of group B Streptococcus (GBS) infections in neonatal intensive care units (NICU) are poorly documented. We aimed to assess GBS cross-transmission during an outbreak of GBS sepsis. METHODS The study was carried out between October and November 2021 in a French University Hospital. Neonatal intensive care unit (NICU) patients with GBS sepsis were included. Clinical data were retrieved from electronic patient records. Group B Streptococcus isolates were characterized at the molecular level using capsular genotyping and whole-genome sequencing (WGS). RESULTS The outbreak of GBS sepsis affected three very preterm neonates with a gestational age of less than 26 weeks, including one recurrent male index case aged 26 days, and two female secondary cases aged 5 and 17 days. The microbiological investigation identified a GBS isolate of capsular type III and Sequence Type 17 as responsible for the four infectious episodes. Whole-genome sequencing confirmed the identity between the isolates. The outbreak and the results of the microbiological investigations led to an immediate reinforcement of hygiene measures. CONCLUSION Clustered cases of GBS infections in NICU and horizontal transmission of the hypervirulent GBS Sequence Type 17 are likely underestimated. Prospective investigation of all nosocomial cases using WGS should contribute to improving vigilance regarding GBS cross-transmission and infection prevention.
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Affiliation(s)
- Nicolas Delettre
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Elodie Billion
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Pierre-Henri Jarreau
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Juliana Patkaï
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
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22
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Tonen-Wolyec S, Otuli NL, Otsatre-Okuti M, Atenyi-Kasemire R, Dupont R, Bélec L. Analytical performances of a point-of-care loop-mediated isothermal amplification assay to detect Group B Streptococcus in intrapartum pregnant women living in the Democratic Republic of the Congo. Int J Infect Dis 2024; 142:106972. [PMID: 38387704 DOI: 10.1016/j.ijid.2024.02.015] [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: 11/07/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Group B Streptococcus (GBS) is the leading infectious cause of stillbirth and neonatal morbidity and mortality in sub-Saharan Africa. METHODS Vaginal and rectovaginal swab samples were obtained from 274 intrapartum pregnant women in the Democratic Republic of the Congo to be analyzed for GBS DNA detection in parallel by the point-of-care BIOSYNEX AMPLIFLASH® GBS assay (Biosynex SA, Illkirch-Graffenstaden, France) and by reference quantitative polymerase chain reaction (qPCR). RESULTS Rectovaginal swabbing, nearly two-fold more positive for GBS than vaginal swabbing alone, showed a high prevalence of GBS DNA positivity in 20.1% of eligible intrapartum pregnant women. In the event of significant bacterial carriage (i.e., cycle threshold ≤33 by reference qPCR), the AMPLIFLASH® GBS assay with rectovaginal swabbing showed high sensitivity (98.1%) and specificity (100.0%) for GBS DNA detection, with excellent concordance, reliability, and accuracy with the reference qPCR, and positive predictive values and negative predictive values above 99.0%. CONCLUSIONS The study demonstrates a high rate of female rectogenital GBS colonization in pregnant Congolese women. The AMPLIFLASH® GBS assay harbored excellent analytical performances in the field, which makes it suitable to be used as point-of-care molecular assay in various hospital and non-hospital settings where rapid diagnosis of GBS is necessary.
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Affiliation(s)
- Serge Tonen-Wolyec
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo; Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo.
| | - Noel Labana Otuli
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, Democratic Republic of the Congo
| | - Monde Otsatre-Okuti
- Faculté de Médecine, Université de Bunia, Bunia, Democratic Republic of the Congo
| | | | - Raphael Dupont
- Laboratoire d'analyses médicales, Centre Cardiologique du Nord (CCN), Saint-Denis, France
| | - Laurent Bélec
- Laboratoire de virologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, Paris, France
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23
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Bourrel AS, Picart A, Fernandez JC, Hays C, Mignon V, Saubaméa B, Poyart C, Fouet A, Tazi A, Guignot J. Specific interaction between Group B Streptococcus CC17 hypervirulent clone and phagocytes. Infect Immun 2024; 92:e0006224. [PMID: 38514466 PMCID: PMC11003227 DOI: 10.1128/iai.00062-24] [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: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
Streptococcus agalactiae also named Group B Streptococcus (GBS) is the most significant pathogen causing invasive infections, such as bacteremia and meningitis, in neonates. Worldwide epidemiological studies have shown that a particular clonal complex (CC) of capsular serotype III, the CC17, is strongly associated with meningitis in neonates and is therefore, designated as the hypervirulent clone. Macrophages are a permissive niche for intracellular bacteria of all GBS clones. In this study, we deciphered the specific interaction of GBS CC17 strains with macrophages. Our study revealed that CC17 strains are phagocytosed at a higher rate than GBS non-CC17 strains by human monocytes and macrophages both in cellular models and in primary cells. CC17-enhanced phagocytosis is due to an initial enhanced-attachment step to macrophages mediated by the CC17-specific surface protein HvgA and the PI-2b pilus (Spb1). We showed that two different inhibitors of scavenger receptors (fucoidan and poly(I)) specifically inhibited CC17 adhesion and phagocytosis while not affecting those of non-CC17 strains. Once phagocytosed, both CC17 and non-CC17 strains remained in a LAMP-1 positive vacuole that ultimately fuses with lysosomes where they can survive at similar rates. Finally, both strains displayed a basal egress which occurs independently from actin and microtubule networks. Our findings provide new insights into the interplay between the hypervirulent GBS CC17 and major players of the host's innate immune response. This enhanced adhesion, leading to increased phagocytosis, could reflect a peculiar capacity of the CC17 lineage to subvert the host immune defenses, establish a niche for persistence or disseminate.
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Affiliation(s)
- Anne-Sophie Bourrel
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Amandine Picart
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | | | - Constantin Hays
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Virginie Mignon
- Plateforme PICMO, US25 INSERM, UAR3612 CNRS, Faculté de Pharmacie, Université Paris Cité, Paris, France
| | - Bruno Saubaméa
- Plateforme PICMO, US25 INSERM, UAR3612 CNRS, Faculté de Pharmacie, Université Paris Cité, Paris, France
| | - Claire Poyart
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Agnès Fouet
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Julie Guignot
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
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Kabiri D, Paltiel O, Ofek-shlomai N, Nir-Paz R, Sompolinsky Y, Ezra Y. Membrane stripping in group B streptococcus carriers does not impede adequate intrapartum antibiotic prophylaxis: a retrospective study. Front Med (Lausanne) 2024; 11:1368998. [PMID: 38646549 PMCID: PMC11026581 DOI: 10.3389/fmed.2024.1368998] [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: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Objective Membrane stripping in group B streptococcus (GBS) carriers poses an increased risk of inadequate antibiotic prophylaxis, potentially due to accelerated labor, thereby potentially impacting the management of GBS colonization during delivery. We compared the adequacy of intrapartum antibiotic prophylaxis between pregnant women colonized with GBS, who underwent membrane stripping and those who did not. The study aimed to determine whether the performance of membrane stripping, by potentially shortening labor duration, increases the risk of inadequate antibiotic prophylaxis dispensation. Study design A retrospective cohort study was conducted on GBS screen-positive women with a full-term singleton pregnancy in cephalic presentation, who were eligible for vaginal delivery. The exposed group consisted of women who underwent membrane stripping, while the unexposed group consisted of women who did not undergo membrane stripping. The primary outcome was defined as inadequate duration of antibiotic prophylaxis during labor, wherein less than 4 h of beta-lactam antibiotics were administered prior to delivery. Neonatal outcome was compared between the groups. Results This retrospective cohort study comprised 1,609 women, with 129 in the exposed group (stripping group) and 1,480 in the unexposed group (no stripping group). Adequate intrapartum antibiotic prophylaxis was received by 64.3% (83/129) of the exposed group, compared to 46.9% (694/1,480) of the unexposed group (p = 0.003). Membrane stripping was associated with increased odds of receiving adequate prophylaxis (OR 1.897, 95% CI 1.185-3.037, p = 0.008). After excluding women who presented to the labor ward in active labor and delivered in less than 4 h, both the exposed and unexposed groups had similarly high rates of adequate intrapartum antibiotic prophylaxis (87.5% vs. 85.8%, respectively). No significant difference was observed in adverse neonatal outcomes between the groups. Conclusion The provision of membrane stripping did not impede adequate intrapartum antibiotic prophylaxis and was correlated with a higher rate of sufficient prophylaxis in comparison to non-swept patients. These observations suggest that membrane stripping can be considered a safe option for ensuring adequate antibiotic prophylaxis in women colonized with GBS.
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Affiliation(s)
- Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Hebrew Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Noa Ofek-shlomai
- Department of Neonatology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew Medical Center and Faculty of Medicine, Jerusalem, Israel
| | - Yishai Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Hebrew Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Thapa R, Goh KGK, Desai D, Copeman E, Acharya D, Sullivan MJ, Ulett GC. Alterations in cell arrangements of group B streptococcus due to virulence factor expression can bias estimates of bacterial populations based on colony count measures. MICROBIOLOGY (READING, ENGLAND) 2024; 170:001453. [PMID: 38656296 PMCID: PMC11084685 DOI: 10.1099/mic.0.001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
Group B streptococcus (GBS) is a chain-forming commensal bacterium and opportunistic pathogen that resides in the gastrointestinal and genitourinary tract of healthy adults. GBS can cause various infections and related complications in pregnant and nonpregnant women, adults, and newborns. Investigations of the mechanisms by which GBS causes disease pathogenesis often utilize colony count assays to estimate bacterial population size in experimental models. In other streptococci, such as group A streptococcus and pneumococcus, variation in the chain length of the bacteria that can occur naturally or due to mutation can affect facets of pathogenesis, such as adherence to or colonization of a host. No studies have reported a relationship between GBS chain length and pathogenicity. Here, we used GBS strain 874391 and several derivative strains displaying longer chain-forming phenotypes (874391pgapC, 874391ΔcovR, 874391Δstp1) to assess the impact of chain length on bacterial population estimates based on the colony-forming unit (c.f.u.) assay. Disruption of GBS chains via bead beating or sonication in conjunction with fluorescence microscopy was used to compare chaining phenotypes pre- and post-disruption to detect long- and short-chain forms, respectively. We used a murine model of GBS colonization of the female reproductive tract to assess whether chaining may affect bacterial colonization dynamics in the host during chronic infection in vivo. Overall, we found that GBS exhibiting long-chain form can significantly affect population size estimates based on the colony count assay. Additionally, we found that the length of chaining of GBS can affect virulence in the reproductive tract colonization model. Collectively, these findings have implications for studies of GBS that utilize colony count assays to measure GBS populations and establish that chain length can affect infection dynamics and disease pathogenesis for this important opportunistic pathogen.
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Affiliation(s)
- Ruby Thapa
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Kelvin G. K. Goh
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Devika Desai
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Ellen Copeman
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Dhruba Acharya
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
| | - Matthew J. Sullivan
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Glen C. Ulett
- School of Pharmacy and Medical Sciences and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia
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26
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Okumura MC, Aragon DC, Carvalheiro CG, Quintana SM, Mussi-Pinhata MM. High Incidence Rates of Early-onset Bacterial Sepsis in Infants Born in Two Brazilian Maternities: A 15-Year Retrospective Analysis. Pediatr Infect Dis J 2024; 43:271-277. [PMID: 38241655 DOI: 10.1097/inf.0000000000004196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Data on the burden and etiology of neonatal early-onset bacterial sepsis (EOBS) in low-to-middle-income countries are scarce. Surveillance is critical for optimizing prevention and treatment strategies. We aimed to estimate the incidence of EOBS in 2 large Brazilian cohorts of neonates. METHODS Data were retrospectively obtained from 33,794 neonates born between 2009 and 2017 at low-risk (n = 17,981) and high-risk maternity centers (n = 15,813). Blood cultures were taken within 72 hours of life from neonates with perinatal risk factors for EOBS or suspected EOBS. A positive blood culture for a pathogenic microorganism and a compatible clinical evolution confirmed the diagnosis of EOBS. RESULTS One-third of the infants born from high-risk and 18.5% from low-risk maternities were investigated for EOBS. Overall, EOBS was more incident in neonates born in the high-risk facilities [66 cases or 4.2/1000 (95% CI: 3.2-5.3)] than in the low-risk facilities [24 cases or 1.3/1000 (95% CI: 0.9-2.0)]. The incidence rate of EOBS increased with decreasing gestational age (<32 weeks: 20.5/1000; 32-36 weeks: 5.6/1000; ≥37 weeks: 1.5/1000). Group B Streptococcus (GBS) was the agent more frequently identified in high-risk and low-risk maternities: 1.8/1000 (95% CI: 1.1-2.4) and 0.4/1000 (95% CI: 0.2-0.9), respectively. EOBS's overall case fatality rate was 17.8% for all the agents and 22% for GBS. CONCLUSIONS EOBS remains unacceptably high and is frequently fatal in preterm and term infants cared for in high- or low-risk maternities. Because GBS has emerged as the most frequent causative agent, preventive strategies are urgently needed.
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Affiliation(s)
| | | | | | - Silvana Maria Quintana
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
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27
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Park HR, Hogan KA, Harris SM, Chames MC, Loch-Caruso R. Group B streptococcus induces cellular senescence in human amnion epithelial cells through a partial interleukin-1-mediated mechanism. Biol Reprod 2024; 110:329-338. [PMID: 37903065 PMCID: PMC10873272 DOI: 10.1093/biolre/ioad149] [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: 06/22/2023] [Revised: 09/25/2023] [Accepted: 10/24/2023] [Indexed: 11/01/2023] Open
Abstract
Group B streptococcus (GBS) infection is a significant public health concern associated with adverse pregnancy complications and increased neonatal mortality and morbidity. However, the mechanisms underlying the impact of GBS on the fetal membrane, the first line of defense against pathogens, are not fully understood. Here, we propose that GBS induces senescence and inflammatory factors (IL-6 and IL-8) in the fetal membrane through interleukin-1 (IL-1). Utilizing the existing transcriptomic data on GBS-exposed human fetal membrane, we showed that GBS affects senescence-related pathways and genes. Next, we treated primary amnion epithelial cells with conditioned medium from the choriodecidual layer of human fetal membrane exposed to GBS (GBS collected choriodecidual [CD] conditioned medium) in the absence or presence of an IL-1 receptor antagonist (IL-1Ra). GBS CD conditioned medium significantly increased β-galactosidase activity, IL-6 and IL-8 release from the amnion epithelial cells. Cotreatment with IL1Ra reduced GBS-induced β-galactosidase activity and IL-6 and IL-8 secretion. Direct treatment with IL-1α or IL-1β confirmed the role of IL-1 signaling in the regulation of senescence in the fetal membrane. We further showed that GBS CD conditioned medium and IL-1 decreased cell proliferation in amnion epithelial cells. In summary, for the first time, we demonstrate GBS-induced senescence in the fetal membrane and present evidence of IL-1 pathway signaling between the choriodecidua and amnion layer of fetal membrane in a paracrine manner. Further studies will be warranted to understand the pathogenesis of adverse pregnancy outcomes associated with GBS infection and develop therapeutic interventions to mitigate these complications.
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Affiliation(s)
- Hae-Ryung Park
- Department of Environmental Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Kelly A Hogan
- Department of Biochemistry & Molecular Biology, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Sean M Harris
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Mark C Chames
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rita Loch-Caruso
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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28
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Coggins SA, Puopolo KM. Neonatal Group B Streptococcus Disease. Pediatr Rev 2024; 45:63-73. [PMID: 38296778 PMCID: PMC10919294 DOI: 10.1542/pir.2023-006154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Group B Streptococcus (GBS) is an important cause of neonatal sepsis in term and preterm infants. Because GBS colonizes human genitourinary and gastrointestinal tracts, a significant focus of neonatal GBS disease prevention is to interrupt vertical transmission of GBS from mother to infant during parturition. Routine antepartum GBS screening in pregnant women, as well as widespread use of intrapartum antibiotic prophylaxis, have aided in overall reductions in neonatal GBS disease during the past 3 decades. However, neonatal GBS disease persists and may cause mortality and significant short- and long-term morbidity among survivors. Herein, we highlight contemporary epidemiology, microbial pathogenesis, and the clinical presentation spectrum associated with neonatal GBS disease. We summarize obstetric recommendations for antenatal GBS screening, indications for intrapartum antibiotic prophylaxis, and considerations for antibiotic selection. Finally, we review national guidelines for risk assessment and management of infants at risk for GBS disease.
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MESH Headings
- Infant
- Pregnancy
- Female
- Infant, Newborn
- Humans
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Streptococcal Infections/diagnosis
- Streptococcal Infections/drug therapy
- Streptococcal Infections/epidemiology
- Infant, Premature
- Anti-Bacterial Agents/therapeutic use
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Streptococcus agalactiae
- Infectious Disease Transmission, Vertical/prevention & control
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Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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29
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Traoré FB, Sidibé CS, Diallo EHM, Camara BS, Sidibé S, Diallo A, Diarra NH, Ly BA, Ag Ahmed MA, Kayentao K, Touré A, Camara A, Delamou A, Sangho H, Terera I. Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis. Front Public Health 2024; 12:1272193. [PMID: 38327574 PMCID: PMC10847291 DOI: 10.3389/fpubh.2024.1272193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives This study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa. Methods This systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger's regression test were used to assess the publication bias. Results A total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46-26.97) and 36.02% (CI: 26.68-45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6-3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8-4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9-4.1), male sex (OR: 1.2, 95% CI: 1.1-1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5-3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4-5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01-10.9), parity (OR: 0.5, 95% CI: 0.3-0.7), prolonged labor (OR: 3.4, 95% CI: 1.6-6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3-14.3) were significantly associated with maternal sepsis. Conclusion The prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050).
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Affiliation(s)
- Fatoumata Bintou Traoré
- National Institute of Public Health, Bamako, Mali
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Cheick Sidya Sidibé
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU Amsterdam, Amsterdam, Netherlands
| | - El Hadj Marouf Diallo
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Bienvenu Salim Camara
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Sidikiba Sidibé
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alhassane Diallo
- Université de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nielé Hawa Diarra
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Birama Apho Ly
- Faculté de Pharmacie, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
| | - Mohamed Ali Ag Ahmed
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Kassoum Kayentao
- Malaria Research and Training Center, Mali International Center for Excellence in Research, University of Sciences, Techniques, and Technologies of Bamako, Bamako, Mali
| | - Abdoulaye Touré
- Center of Research and Training in Infectious Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alioune Camara
- National Malaria Control Programme Conakry, Conakry, Guinea
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Hamadoun Sangho
- Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
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30
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Grabowska ME, Van Driest SL, Robinson JR, Patrick AE, Guardo C, Gangireddy S, Ong HH, Feng Q, Carroll R, Kannankeril PJ, Wei WQ. Developing and evaluating pediatric phecodes (Peds-Phecodes) for high-throughput phenotyping using electronic health records. J Am Med Inform Assoc 2024; 31:386-395. [PMID: 38041473 PMCID: PMC10797257 DOI: 10.1093/jamia/ocad233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/04/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Pediatric patients have different diseases and outcomes than adults; however, existing phecodes do not capture the distinctive pediatric spectrum of disease. We aim to develop specialized pediatric phecodes (Peds-Phecodes) to enable efficient, large-scale phenotypic analyses of pediatric patients. MATERIALS AND METHODS We adopted a hybrid data- and knowledge-driven approach leveraging electronic health records (EHRs) and genetic data from Vanderbilt University Medical Center to modify the most recent version of phecodes to better capture pediatric phenotypes. First, we compared the prevalence of patient diagnoses in pediatric and adult populations to identify disease phenotypes differentially affecting children and adults. We then used clinical domain knowledge to remove phecodes representing phenotypes unlikely to affect pediatric patients and create new phecodes for phenotypes relevant to the pediatric population. We further compared phenome-wide association study (PheWAS) outcomes replicating known pediatric genotype-phenotype associations between Peds-Phecodes and phecodes. RESULTS The Peds-Phecodes aggregate 15 533 ICD-9-CM codes and 82 949 ICD-10-CM codes into 2051 distinct phecodes. Peds-Phecodes replicated more known pediatric genotype-phenotype associations than phecodes (248 vs 192 out of 687 SNPs, P < .001). DISCUSSION We introduce Peds-Phecodes, a high-throughput EHR phenotyping tool tailored for use in pediatric populations. We successfully validated the Peds-Phecodes using genetic replication studies. Our findings also reveal the potential use of Peds-Phecodes in detecting novel genotype-phenotype associations for pediatric conditions. We expect that Peds-Phecodes will facilitate large-scale phenomic and genomic analyses in pediatric populations. CONCLUSION Peds-Phecodes capture higher-quality pediatric phenotypes and deliver superior PheWAS outcomes compared to phecodes.
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Affiliation(s)
- Monika E Grabowska
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Sara L Van Driest
- Department of Pediatrics and the Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Jamie R Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Anna E Patrick
- Department of Pediatrics and the Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Chris Guardo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Srushti Gangireddy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Henry H Ong
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - QiPing Feng
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Prince J Kannankeril
- Department of Pediatrics and the Center for Pediatric Precision Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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31
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Bjerkhaug AU, Ramalingham S, Mboizi R, Le Doare K, Klingenberg C. The immunogenicity and safety of Group B Streptococcal maternal vaccines: A systematic review. Vaccine 2024; 42:84-98. [PMID: 38072754 DOI: 10.1016/j.vaccine.2023.11.056] [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: 10/24/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024]
Abstract
PURPOSE To systematically review immunogenicity and safety data of maternal group B streptococcal (GBS) vaccines in published clinical trials until July 2023. METHODS EMBASE, MEDLINE, Cochrane Library and clinicaltrial.gov. databases were searched for clinical studies that reported immunogenicity and/or safety of GBS vaccine in non-pregnant adults, pregnant women and infants between 1st of January 1996 to 31st of July 2023. Pairs of reviewers independently selected, data extracted, and assessed the risk of bias of the studies. Discrepancies were resolved by consensus. (PROSPERO CRD42020185213). RESULTS We retrieved 1472 records from the literature search; 20 studies and 6 sub-studies were included, involving 4440 non-pregnant participants and 1325 pregnant women with their newborns. There was a significantly higher IgG Geometric Mean Concentration (GMC) and IgG placental transfer ratios in vaccinated compared to placebo groups, with peak response 4-8 weeks after vaccination. Placental transfer ratio varied from 0.4 to 1.4 across five studies. The different clinical trials used different assays that limited direct comparison. There were no significant differences in the risk of serious adverse events (adjusted OR 0.73; 95 % CI 0.49-1.07), serious adverse events leading to withdrawal (adjusted OR 0.44; 95 % CI 0.13-1.51), and systemic illness or fever (adjusted OR 1.05; 95 % CI 0.26-4.19) between the vaccine and placebo groups. CONCLUSIONS The published clinical trials show significant IgG GMC response in subjects receiving the conjugated capsular polysaccharide and surface subunit protein vaccines compared to placebo. In current clinical trials of experimental GBS maternal vaccines, there have been no observed serious adverse events of special interest directly linked to vaccination.
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Affiliation(s)
- Aline U Bjerkhaug
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Shouwmika Ramalingham
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Robert Mboizi
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda
| | - Kirsty Le Doare
- Makerere University Johns Hopkins University (MU-JHU) Research Collaboration (MUJHU CARE LTD), Kampala, Uganda; Centre for Neonatal and Paediatric Infection, Maternal and Neonatal Vaccine Immunology Research Group, St Georgés University of London, United Kingdom
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
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32
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Wang F, Yi L, Ming F, Dong R, Wang F, Chen R, Hu X, Chen X, Sun B, Tang YW, Zhu Y, Wu L. Evaluation of the Xpert Xpress GBS test for rapid detection of group B Streptococcus in pregnant women. Microbiol Spectr 2024; 12:e0220623. [PMID: 38054718 PMCID: PMC10783076 DOI: 10.1128/spectrum.02206-23] [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: 06/04/2023] [Accepted: 11/10/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE This was the first study evaluating the performance of the Xpert Xpress group B Streptococcus (GBS) test using rectovaginal swabs from Chinese pregnant women. Compared to the other three assays, the Xpert Xpress GBS test demonstrated high sensitivity and specificity when screening 939 pregnant women for GBS in rectovaginal specimens. Additionally, its reduced time to obtain results makes it valuable for the rapid detection of GBS.
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Affiliation(s)
- Feiling Wang
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Lehui Yi
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
- Department of Graduate and Scientific Research, Zunyi Medical University Zhuhai Campus, Zhuhai, Guangdong, China
| | - Fang Ming
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Rui Dong
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Feng Wang
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Ruirui Chen
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Xiaoling Hu
- Clinical Affairs, Cepheid, Sunnyvale, California, USA
| | - Xuri Chen
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Bo Sun
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Yi-Wei Tang
- Medical Affairs, Cepheid, Sunnyvale, California, USA
- Danaher Diagnostic Platform China, Shanghai, China
| | - Yuanfang Zhu
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
| | - Lijuan Wu
- Clinical Laboratory, Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, Guangdong, China
- Department of Obstetrics, Shenzhen Key Medical Discipline, Maternal-Fetal Medicine Institute, Shenzhen Bao'an Women’s and Children’s Hospital, Shenzhen, Guangdong, China
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Matsubara K, Shibata M. Group B Streptococcal Disease in Infants in Japan. Pediatr Infect Dis J 2024; 43:e3-e10. [PMID: 37922509 DOI: 10.1097/inf.0000000000004144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
This review describes the epidemiology of group B Streptococcus (GBS) infection in infants in Japan and discusses unresolved issues and future perspectives. Guidelines for the prevention of vertical transmission in Japan were implemented in 2008. The incidence of early-onset disease in Japan has remained stable at approximately 0.10/1000 livebirths or less, which is lower than in Europe and North America. The incidence of late-onset disease is also low, but has increased over the last decade, with an estimated 0.29/1000 livebirths in 2020. National surveillance studies in 2011-2015 and 2016-2020 reported case fatality rates of 4.5% and 6.5% for early-onset disease and 4.4% and 3.0% for late-onset disease, respectively. Sequelae of neurodevelopmental impairments were considerably associated with infants who developed meningitis. Predominant neonatal invasive strains have remained in the following order of serotypes: III, Ia, Ib and V, for the past 30 years. Conversely, the predominant serotypes of maternal colonization strains markedly changed from serotypes VI and VIII around 2000 to serotypes Ia, Ib, III and V over the last decade. Recurrence rates among infants < 1-year-old were estimated to be 2.8%-3.7%, and preterm birth and antenatal maternal GBS colonization were risk factors for recurrence. Several unresolved issues remain. First, the exact disease burden remains unclear because Japan does not have a nationwide system to register all infants affected by invasive GBS disease, and even population-based surveys are limited to up to 10 of the 47 prefectures. Others include low adherence to prevention guidelines of vertical transmission and the development of strategies based on Japanese epidemiological evidence rather than the Center for Disease Control and Prevention guidelines. The effectiveness of introducing maternal vaccines in Japan, where the disease incidence is low, needs to be carefully verified.
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Affiliation(s)
- Kousaku Matsubara
- From the Department of Pediatrics, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Meiwa Shibata
- Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Mynarek M, Vik T, Andersen GL, Brigtsen AK, Hollung SJ, Larose TL, Lydersen S, Olsen LC, Strøm MS, Afset JE. Mortality and neurodevelopmental outcome after invasive group B streptococcal infection in infants. Dev Med Child Neurol 2024; 66:125-133. [PMID: 37306102 DOI: 10.1111/dmcn.15643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
AIM To assess case fatality rate (CFR), infant mortality, and long-term neurodevelopmental disorders (NDDs) after invasive group B streptococcal (GBS; Streptococcus agalactiae) infection in infants. METHOD Children born in Norway between 1996 and 2019 were included. Data on pregnancies/deliveries, GBS infection, NDDs, and causes of death were retrieved from five national registries. The exposure was culture-confirmed invasive GBS infection during infancy. Outcomes were mortality and NDDs, the latter at a mean age of 12 years 10 months. RESULTS Among 1 415 625 live-born children, 866 (87%) of 1007 infants diagnosed with GBS infection (prevalence 0.71 per 1000) were included. The CFR was 5.0% (n = 43). GBS infection was associated with higher infant mortality (relative risk 19.41; 95% confidence interval [CI] 14.79-25.36) than the general population. Among survivors, 169 (20.7%) children were diagnosed with any NDD (relative risk 3.49; 95% CI 3.05-3.98). In particular, GBS meningitis was associated with high risks of attention-deficit/hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, and pervasive and specific developmental disorder. INTERPRETATION The burden of invasive GBS infection during infancy is considerable and continues to affect children beyond infancy. These findings emphasize the need for new preventive strategies for disease reduction, and the need for survivors to be directly included into early detection pathways to access early intervention if required. WHAT THIS PAPER ADDS The burden of invasive group B streptococcal (GBS) infection in Norway is considerable. Of GBS infection survivors, 20.7% were diagnosed with neurodevelopmental disorders (NDDs) at mean age 12 years 10 months. Infants with GBS meningitis were more often diagnosed with NDDs. Absolute risks associated with GBS infections were highest for pervasive and specific developmental disorder, cerebral palsy, and attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Maren Mynarek
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro L Andersen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne K Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Sandra Julsen Hollung
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Vestfold Hospital Trust, Tønsberg, Norway
| | - Tricia L Larose
- Department of Health Registries, Division Digitalization and Health Registries, Norwegian Directorate of Health, Oslo, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene C Olsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- BioCore Bioinformatics Core Facility, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne S Strøm
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Jan E Afset
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Kawai S, Miyoshi-Akiyama T, Katano H, Sunagawa K. Invasive Streptococcus agalactiae (group B streptococcus) infection with toxic shock-like syndrome: A report of a fatal non-pregnant case and a review of the literature. J Infect Chemother 2024; 30:71-76. [PMID: 37716644 DOI: 10.1016/j.jiac.2023.09.003] [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: 03/10/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
Streptococcus agalactiae (group B streptococcus; GBS) is a Gram-positive coccus. It has emerged as a cause of significant infections in non-pregnant adults, particularly neonates and individuals aged 65 years or older, which can lead to fatal outcomes. Streptococcal toxic shock-like syndrome (STSS) is an acute illness, which is mainly caused by exotoxin-producing strains of Streptococcus pyogenes and may result in death. In this report, we present a fatal non-pregnant case of STSS induced by GBS in a 45-year-old healthy female. The patient presented with fever, polyarthralgia, myalgia, and skin erythema. Matrix Assisted Laser Desorption/Ionization‒Time of Flight Mass Spectrometry (MALDI-TOF-MS) and PCR identified GBS in colonies from her blood and urine cultures, and she was diagnosed with septicemia and STSS. On the sixth day of her illness, she died from acute respiratory distress syndrome and multiple organ dysfunction syndrome. Whole-genome sequencing revealed the presence of several virulence genes in the genome of the GBS strain detected in the blood cultures, which may have contributed to the development of STSS and the patient's death.
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Affiliation(s)
- Shiori Kawai
- Internal Medicine, Saitama Cooperative Hospital, Saitama, Japan; Department of Diabetes, Endocrinology, and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan
| | - Keishin Sunagawa
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan; Department of Clinical Laboratory Medicine, Chiba Nishi General Hospital, Chiba, Japan.
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Russell N, Barday M, Okomo U, Dramowski A, Sharland M, Bekker A. Early-versus late-onset sepsis in neonates - time to shift the paradigm? Clin Microbiol Infect 2024; 30:38-43. [PMID: 37517521 DOI: 10.1016/j.cmi.2023.07.023] [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: 11/07/2022] [Revised: 05/31/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Neonatal sepsis is traditionally classified as early-onset sepsis (EOS) and late-onset sepsis (LOS) disease categories. This paradigm was based on observed epidemiological data from high income settings. However, increasing availability of microbiology results from diverse settings challenges these assumptions, necessitating re-examination of neonatal sepsis classifications. OBJECTIVES To review the literature describing the aetiology of EOS and LOS in hospitalized neonates with stratification of pathogen spectrum by low- (LIC), middle- (MIC) and high-income (HIC) country settings, to critically re-examine the continued appropriateness of the 'EOS vs. LOS' sepsis paradigm in all settings. SOURCES PubMed was searched for peer-reviewed English full-text articles published from inception up until 8 August 2022. CONTENT Studies often report on either EOS or LOS, rather than both. We identified only 49 original articles reporting on pathogen distribution of both EOS and LOS in the same hospital setting. Clear differences in sepsis aetiology were shown between LIC, MIC and HIC settings, with increasing importance of Klebsiella pneumoniae and decreasing importance of Group B Streptococcus in the first 72 hours of life in LIC and MIC. IMPLICATIONS The concept of 'EOS vs. LOS' may be less useful for predicting the pathogen spectrum of neonatal sepsis in LIC and MIC, but the paradigm has shaped reporting of neonatal sepsis, and our understanding. Future neonatal sepsis reporting should utilize strengthening the reporting of observational studies in epidemiology for newborn infection (STROBE-NI) reporting guidelines and clearly describe timing of infection by day, and variation in pathogen spectrum across the neonatal period. Data identified in this review challenge the generalizability of the prevailing EOS/LOS paradigm in LIC and MIC.
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Affiliation(s)
- Neal Russell
- Centre for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George's University of London, London, UK.
| | - Mikhail Barday
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Uduak Okomo
- Vaccines & Immunity Theme, MRC Unit the Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection (CNPI), Institute of Infection & Immunity, St George's University of London, London, UK
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Kharrat R, Ben Ayed N, Ktari S, Regaieg C, Mezghani S, Hmida N, Mahjoubi F, Gargouri A, Hammami A. Group B Streptococcus and Perinatality in the South of Tunisia: Epidemiology, Serotype Distribution, and Antibiotic Susceptibility. Fetal Pediatr Pathol 2024; 43:21-32. [PMID: 38069499 DOI: 10.1080/15513815.2023.2287519] [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: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION In the lack of updated Tunisian epidemiological data, we sought to describe the epidemiology of Group B Streptococcus (GBS) in pregnant women and newborns. MATERIALS AND METHODS A retrospective analysis of GBS neonatal invasive infections and a cross-sectional study evaluating the prevalence of maternal GBS colonization were conducted. GBS isolates were tested for antimicrobial susceptibility, serotyped, and assessed for the appurtenance to the hypervirulent ST17 clone. RESULTS Of 98 neonates with GBS, early-onset GBS disease (EOD) comprised 83.7 and 16.3% were late-onset GBS disease (LOD). The prevalence of maternal GBS colonization was 27%. All GBS isolates were susceptible to penicillin. Serotype III predominated (42.6%) for neonatal invasive infections. GBS isolates belonging to the ST17 sequence type were found only as serotype III. CONCLUSION This study documents the frequency of GBS EOD, the high rate of maternal GBS colonization, and the predominance of the hypervirulent clone type III/ST17 in infants.
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Affiliation(s)
- Rim Kharrat
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nourelhouda Ben Ayed
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Ktari
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Chiraz Regaieg
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sonda Mezghani
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nedia Hmida
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Faouzia Mahjoubi
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdellatif Gargouri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Adnene Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Björklund V, Saxén H, Hertting O, Malchau Carlsen EL, Hoffmann S, Håkansson S, Stefánsson Thors V, Haraldsson Á, Brigtsen AK, Döllner H, Huhtamäki H, Pokka T, Ruuska TS. Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019. Euro Surveill 2024; 29:2300193. [PMID: 38240058 PMCID: PMC10797658 DOI: 10.2807/1560-7917.es.2024.29.3.2300193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 01/22/2024] Open
Abstract
BackgroundNeonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.AimThe aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.MethodsIn 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.ResultsIn Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.ConclusionsIn this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.
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Affiliation(s)
- Verna Björklund
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxén
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olof Hertting
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emma Louise Malchau Carlsen
- Department of Intensive Care for Newborns and Infants, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Stellan Håkansson
- Department of Clinical Science/Paediatrics, Umeå University, Umeå, Sweden
| | - Valtýr Stefánsson Thors
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Döllner
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Children's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Heikki Huhtamäki
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Terhi Susanna Ruuska
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Biocenter Oulu and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Greenfield KG, Harlow OS, Witt LT, Dziekan EM, Tamar CR, Meier J, Brumbaugh JE, Levy ER, Knoop KA. Neonatal intestinal colonization of Streptococcus agalactiae and the multiple modes of protection limiting translocation. Gut Microbes 2024; 16:2379862. [PMID: 39042143 PMCID: PMC11268251 DOI: 10.1080/19490976.2024.2379862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a predominant pathogen of neonatal sepsis, commonly associated with early-onset neonatal sepsis. GBS has also been associated with cases of late-onset sepsis potentially originating from the intestine. Previous findings have shown GBS can colonize the infant intestinal tract as part of the neonatal microbiota. To better understand GBS colonization dynamics in the neonatal intestine, we collected stool and milk samples from prematurely born neonates for identification of potential pathogens in the neonatal intestinal microbiota. GBS was present in approximately 10% of the cohort, and this colonization was not associated with maternal GBS status, delivery route, or gestational weight. Interestingly, we observed the relative abundance of GBS in the infant stool negatively correlated with maternal IgA concentration in matched maternal milk samples. Using a preclinical murine model of GBS infection, we report that both vertical transmission and direct oral introduction resulted in intestinal colonization of GBS; however, translocation beyond the intestine was limited. Finally, vaccination of dams prior to breeding induced strong immunoglobulin responses, including IgA responses, which were associated with reduced mortality and GBS intestinal colonization. Taken together, we show that maternal IgA may contribute to infant immunity by limiting the colonization of GBS in the intestine.
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Affiliation(s)
| | | | - Lila T Witt
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Jane E Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emily R Levy
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kathryn A Knoop
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Du J, Ji W, Zhao H, McIver DJ, Zhao Y, Chang J, Fang Y. Preferences of pregnant women toward a future maternal Group B Streptococcus vaccine in China: A cross-sectional survey with a discrete choice experiment. Hum Vaccin Immunother 2023; 19:2281713. [PMID: 38175949 PMCID: PMC10760376 DOI: 10.1080/21645515.2023.2281713] [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: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 01/06/2024] Open
Abstract
Group B streptococcus (GBS) is a major cause of neonatal death worldwide. A GBS vaccine for pregnant women is under development and is expected to be available in the near future. The perceptions and preferences of pregnant women in China of GBS vaccines has not been investigated, and this study aimed to investigate pregnant women's awareness of GBS and their potential preferences for the GBS vaccine. A discrete choice experiment was conducted among pregnant women in hospitals from Shaanxi, Hunan, and Zhejiang provinces located in Western, Central, and Eastern China, respectively. A conditional logit model was used to analyze the data and calculate willingness to pay values and choice probabilities of different GBS vaccine programs. A total of 354 pregnant women were included in the final analysis, 45.8% of whom were willing to receive a GBS vaccine if it were licensed. Vaccine safety was the most important attribute of a future vaccine, while cost was the least important attribute. Compared with no vaccination, pregnant women had a strong preference for future GBS vaccination (ASC = 1.267, p < .001). Pregnant women's decisions were highly influenced by those of other pregnant women. Improving the safety, efficacy, and vaccination rate of the GBS vaccine in China is of great significance for future GBS vaccine development and vaccination. Compared to other variable options, the cost of a GBS vaccine was of the least importance among pregnant women in mainland China. These findings can inform public health policy decisions related to GBS vaccination in China.
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Affiliation(s)
- Jiaxi Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Hang Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - David J. McIver
- Institute for Global Health Sciences, University of California, San Fransisco, CA, USA
| | - Yifei Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, China
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China’s Western Technological Innovation Harbor, Xi’an, China
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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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Hanze Villavicencio KL, Job MJ, Burghard AC, Taffet A, Banda FM, Vurayai M, Mokomane M, Arscott-Mills T, Mazhani T, Nchingane S, Thomas B, Steenhoff AP, Ratner AJ. Genomic Analysis of Group B Streptococcus Carriage Isolates From Botswana Reveals Distinct Local Epidemiology and Identifies Novel Strains. Open Forum Infect Dis 2023; 10:ofad496. [PMID: 37869411 PMCID: PMC10588617 DOI: 10.1093/ofid/ofad496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
In pregnant people colonized with group B Streptococcus (GBS) in Botswana, we report the presence/expansion of sequence types 223 and 109, a low rate of erythromycin resistance, and 3 novel sequence types. These data highlight the importance of local epidemiologic studies of GBS, a significant source of neonatal disease.
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Affiliation(s)
- Karen L Hanze Villavicencio
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan J Job
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Anne Claire Burghard
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NewYork, USA
| | - Allison Taffet
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Francis M Banda
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Moses Vurayai
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Margaret Mokomane
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tiny Mazhani
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Brady Thomas
- Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam J Ratner
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NewYork University Grossman School of Medicine, New York, New York, USA
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Laycock KM, Acosta F, Valera S, Villegas A, Mejia E, Mateo C, Felipe R, Fernández A, Job M, Dongas S, Steenhoff AP, Ratner AJ, Geoghegan S. Near-term pregnant women in the Dominican Republic experience high rates of Group B Streptococcus rectovaginal colonization with virulent strains. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002281. [PMID: 37733668 PMCID: PMC10513192 DOI: 10.1371/journal.pgph.0002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023]
Abstract
Maternal colonization with Group B Streptococcus (GBS) is an important cause of stillbirth, prematurity, and serious infection and death in infants worldwide. Resource constraints limit prevention strategies in many regions. Maternal GBS vaccines in development could be a more accessible prevention strategy, but data on geographic variations in GBS clones are needed to guide development of a broadly effective vaccine. In the Dominican Republic (DR), limited data suggest that pregnant women experience GBS colonization at rates among the highest globally. We aimed to determine the prevalence of maternal rectovaginal GBS colonization and describe clonal characteristics of colonizing strains in the DR. A cross-sectional study assessed rectovaginal GBS colonization in 350 near-term pregnant women presenting for routine prenatal care at an urban tertiary center in the DR. Rectovaginal samples were tested with chromogenic Strep B Carrot Broth and cultured for confirmatory whole-genome sequencing. In a secondary analysis, participants' demographics and histories were assessed for association with GBS colonization. Rectovaginal GBS colonization occurred in 26.6% of women. Serotypes Ia, Ib, II, III, IV, and V were detected, with no one serotype predominating; serotype III was identified most frequently (21.5%). Virulent and emerging strains were common, including CC17 (15.1%) and ST1010 (17.2%). In this first characterization of maternal GBS serotypes in the DR, we found high rates of rectovaginal colonization including with virulent and emerging GBS strains. The serotypes observed here are all targeted by candidate hexavalent GBS vaccines, suggesting effective protection in the DR.
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Affiliation(s)
- Katherine M. Laycock
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | | | - Sandra Valera
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Ana Villegas
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Elia Mejia
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Christian Mateo
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Rosa Felipe
- Hospital Materno Infantil San Lorenzo de Los Mina, Santo Domingo, Dominican Republic
| | - Anabel Fernández
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Megan Job
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Sophia Dongas
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Andrew P. Steenhoff
- Global Health Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Adam J. Ratner
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York, United States of America
- Department of Microbiology, Grossman School of Medicine, New York University, New York, New York, United States of America
| | - Sarah Geoghegan
- Division of Paediatric Infectious Diseases, Children’s Health Ireland at Crumlin, Dublin, Ireland
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Vaz MJ, Dongas S, Ratner AJ. Capsule production promotes Group B Streptococcus intestinal colonization. Microbiol Spectr 2023; 11:e0234923. [PMID: 37732775 PMCID: PMC10655599 DOI: 10.1128/spectrum.02349-23] [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: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 09/22/2023] Open
Abstract
Late-onset disease is the most common clinical presentation of Group B Streptococcus (GBS) infection during infancy, and gastrointestinal (GI) colonization is an important precursor. Previously, we described a murine model of postnatal GBS GI colonization that resulted in sustained colonization and progression to invasive disease. Capsular polysaccharide is an important GBS virulence factor. Vaccines based on a subset of capsular serotypes are in clinical trials. However, little is known regarding the role of specific GBS capsular serotypes in GI colonization. We examined the role of GBS capsule in GI colonization using capsule-producing and acapsular strains derived from GBS strain A909 (serotype Ia) in a murine model. Using isogenic GBS strains differing only in capsular serotypes, we explored the role of specific serotypes in GI colonization by determining competitive indices during cocolonization. We found that GBS A909 colonizes the murine GI tract without causing invasive disease. In monocolonization experiments, there was colonization persistence with the capsule-producing strain (100%) compared to the acapsular mutant strain (13%). In cocolonization experiments, the capsule-producing strain outcompeted its isogenic acapsular mutant, with a geometric mean competitive index of 8, 95% confidence interval (CI) [1.7, 38.9] in the colon at 7 days post-colonization. A909 expressing its native serotype Ia capsule outcompeted an isogenic mutant that expresses serotype III capsule, with a geometric mean competitive index of 2.5, 95% CI [1.2, 5.1] in the colon at 7 days post-colonization. Thus, polysaccharide capsule production enhances GBS GI colonization in vivo. In an A909 genetic background, the production of a serotype Ia capsule provides a competitive advantage over an isogenic strain producing type III capsule. The murine model is a valuable tool to understand the role of GBS capsule types in GI colonization. IMPORTANCE The establishment of GBS intestinal colonization is believed to be a critical precursor to late-onset disease in neonates, which has a significant impact on neurodevelopment outcomes in this population. Our prior work described a murine model of postnatal Group B Streptococcus (GBS) acquisition and invasive disease. Using this model, we explored the importance of GBS polysaccharide capsule production on gastrointestinal colonization. We found that the expression of capsule (compared to isogenic acapsular strains) provides an advantage in intestinal colonization and, importantly, that capsule type Ia has an advantage over capsule type III in a GBS A909 strain background. We speculate that specific serotypes may differ in colonization fitness, which may play a role in serotype distribution in neonatal disease.
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Affiliation(s)
- Michelle J. Vaz
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Sophia Dongas
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Adam J. Ratner
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
- Department of Microbiology, NYU School of Medicine, New York, New York, USA
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d'Otreppe S, Lefèvre P, Meex C, Devey A, Sacheli R, Gerard M, Melin P. Multicenter Performance Evaluation of the Revogene ® GBS DS Real-Time PCR Assay for Group B Streptococcus Detection During Labor. Mol Diagn Ther 2023; 27:611-620. [PMID: 37470972 DOI: 10.1007/s40291-023-00660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE This study aimed to evaluate the performance and ease of use of the Revogene® GBS DS PCR assay for the intrapartum detection of Group B Streptococcus (GBS) colonization, as compared with intrapartum culture and antenatal culture-based screening. METHODS Between April and August 2019, 398 women who gave birth in one of the three maternities participating in this study agreed to the collection of a vaginal swab when they arrived in the labor ward. The samples were immediately sent to the adjacent laboratory where they were discharged into the buffer provided with the Revogene® GBS DS assay. Part of the buffer was used to perform the Revogene® GBS DS test, and part of the same buffer was used for GBS culture. RESULTS The Revogene® GBS DS assay provided a valid result in less than 70 min for 356 (89%) women. The sensitivity of the test was 85.7% (66.4-95.3%). The specificity of the test was 99.1% (97.3-99.8%). The positive predictive value was 88.9% (69.7-97.1%). The negative predictive value was 98.9% (96.9-99.6%). CONCLUSION The easy-to-use Revogene® GBS DS assay provides a valuable tool for the detection of GBS colonization at the beginning of labor. The sensitivity and turn-around time are adequate. The high number of invalid results needs to be addressed before the Revogene® GBS DS test can be expected to replace the current screening-based approach.
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Affiliation(s)
- Stéphanie d'Otreppe
- Department of Clinical Biology, Hôpital de Marche, Vivalia, Marche-en-Famenne, Belgium. stephanie.d'
| | - Philippe Lefèvre
- Department of Clinical Biology, Hôpital de Marche, Vivalia, Marche-en-Famenne, Belgium
| | - Cécile Meex
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
- National Reference Center Streptococcus agalactiae, Department of Clinical Microbiology, University Hospital Center of Liege, Liege, Belgium
| | - Anaïs Devey
- Department of Clinical Biology, Hôpital de Libramont, Vivalia, Libramont-Chevigny, Belgium
| | - Rosalie Sacheli
- National Reference Center Streptococcus agalactiae, Department of Clinical Microbiology, University Hospital Center of Liege, Liege, Belgium
| | - Martin Gerard
- Department of Obstetrics and Gynecology, Hôpital de Marche, Vivalia, Marche-en-Famenne, Belgium
| | - Pierrette Melin
- Department of Clinical Microbiology, University Hospital of Liege, Liege, Belgium
- National Reference Center Streptococcus agalactiae, Department of Clinical Microbiology, University Hospital Center of Liege, Liege, Belgium
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Elangovan D, Neeravi A, Sahni RD, Santhanam S, Beck MM, Adhiya R, Kwatra G, Solaimalai D, Veeraraghavan B. Serotype distribution and antimicrobial susceptibility profile of invasive group B streptococcal disease-in South Indian population. Indian J Med Microbiol 2023; 45:100392. [PMID: 37573061 DOI: 10.1016/j.ijmmb.2023.100392] [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: 03/03/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Invasive group B Streptococcal disease (iGBS) is an important cause of morbidity and mortality in neonates for which the development of an efficacious vaccine remains a global health imperative. The knowledge about the serotype distribution of iGBS is important component for formulation of Capsular polysaccharide (CPS)-based vaccine. However, there were absolute lack of information on serotype distribution in invasive GBS isolates from Indian subcontinent. Methods This study has assessed the serotype distribution and antimicrobial susceptibility profile of invasive group B streptococcal isolates for a period of 13 years from 2009 to 2022 from a tertiary care Center in South India. A total of 155 iGBS isolates were subjected to serotyping by conventional multiplex PCR for identification of all ten GBS serotype. Antimicrobial susceptibility profile and demographic details were extracted from microbiological records. Results Overall, the most common serotype causing invasive GBS were Ia (29%), V (26%), III (15%), II (12%), VI (6%), VII (5%) and Ib (5%). Serotypes IV, VIII and XI were not detected. Among the early-onset iGBS, the common serotype were Ia (36%), V (27%), and III (8%). In late onset iGBS, Serotype III (44%) was predominant. The common serotype in adults were Serotype V (31%) and III (20%). All the invasive GBS isolates were susceptible for penicillin (100%), but the susceptibility for clindamycin and erythromycin were 72% and 80% respectively. Conclusion The serotype distribution of invasive Group B streptococcal isolates from India suggest that hexavalent group B CPS vaccine will cover only 90% of GBS isolates causing invasive disease among the infants in India. Continued surveillance monitoring for serotype distribution and antimicrobial resistance patterns for iGBS are warranted to make public health interventions.
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Affiliation(s)
- Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, India.
| | - Ayyanraj Neeravi
- Department of Clinical Microbiology, Christian Medical College, Vellore, India.
| | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, India.
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, India.
| | - Manisha Madhai Beck
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.
| | - Ranjan Adhiya
- Department of Clinical Microbiology, Christian Medical College, Vellore, India.
| | - Gaurav Kwatra
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa; MRC, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
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Grabowska ME, Van Driest SL, Robinson JR, Patrick AE, Guardo C, Gangireddy S, Ong H, Feng Q, Carroll R, Kannankeril PJ, Wei WQ. Developing and Evaluating Pediatric Phecodes (Peds-Phecodes) for High-Throughput Phenotyping Using Electronic Health Records. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.22.23294435. [PMID: 37662278 PMCID: PMC10473796 DOI: 10.1101/2023.08.22.23294435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Objective Pediatric patients have different diseases and outcomes than adults; however, existing phecodes do not capture the distinctive pediatric spectrum of disease. We aim to develop specialized pediatric phecodes (Peds-Phecodes) to enable efficient, large-scale phenotypic analyses of pediatric patients. Materials and Methods We adopted a hybrid data- and knowledge-driven approach leveraging electronic health records (EHRs) and genetic data from Vanderbilt University Medical Center to modify the most recent version of phecodes to better capture pediatric phenotypes. First, we compared the prevalence of patient diagnoses in pediatric and adult populations to identify disease phenotypes differentially affecting children and adults. We then used clinical domain knowledge to remove phecodes representing phenotypes unlikely to affect pediatric patients and create new phecodes for phenotypes relevant to the pediatric population. We further compared phenome-wide association study (PheWAS) outcomes replicating known pediatric genotype-phenotype associations between Peds-Phecodes and phecodes. Results The Peds-Phecodes aggregate 15,533 ICD-9-CM codes and 82,949 ICD-10-CM codes into 2,051 distinct phecodes. Peds-Phecodes replicated more known pediatric genotype-phenotype associations than phecodes (248 versus 192 out of 687 SNPs, p<0.001). Discussion We introduce Peds-Phecodes, a high-throughput EHR phenotyping tool tailored for use in pediatric populations. We successfully validated the Peds-Phecodes using genetic replication studies. Our findings also reveal the potential use of Peds-Phecodes in detecting novel genotype-phenotype associations for pediatric conditions. We expect that Peds-Phecodes will facilitate large-scale phenomic and genomic analyses in pediatric populations. Conclusion Peds-Phecodes capture higher-quality pediatric phenotypes and deliver superior PheWAS outcomes compared to phecodes.
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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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50
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Cowley ES, Chaves IZ, Osman F, Suen G, Anantharaman K, Hryckowian AJ. Determinants of Gastrointestinal Group B Streptococcus Carriage in Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.17.553755. [PMID: 37645860 PMCID: PMC10462156 DOI: 10.1101/2023.08.17.553755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Streptococcus agalactiae (Group B Streptococcus, GBS) is a commensal Gram-positive bacterium found in the human gastrointestinal and urogenital tracts. Much of what is known about GBS relates to the diseases it causes in pregnant people and neonates. However, GBS is a common cause of disease in the general population with 90% of GBS mortality occurring in non-pregnant people. There are limited data about the predisposing factors for GBS and the reservoirs in the body. To gain an understanding of the determinants of gastrointestinal GBS carriage, we used stool samples and associated metadata to determine the prevalence and abundance of GBS in the gut microbiome of adults and find risk factors for GBS status. Methods We used 754 stool samples collected from adults in Wisconsin from 2016-2017 to test for the prevalence and abundance of GBS using a Taqman probe-based qPCR assay targeting two GBS-specific genes: cfp and sip. We compared the microbiome compositions of the stool samples by GBS status using 16S rRNA analysis. We compared associations with GBS status and 557 survey variables collected during sample acquisition (demographics, diet, overall health, and reproductive health) using univariate and multivariate analyses. Results We found 137/754 (18%) of participants had detectable GBS in their stool samples with a median abundance of 104 copies per nanogram of starting DNA. There was no difference in GBS status or abundance based on gender. Beta-diversity, Bray-Curtis and Unweighted UniFrac, was significantly different based on carrier status of the participant. Prior to p-value correction, 59/557 (10.6%) survey variables were significantly associated with GBS carrier status and 11/547 (2.0%) variables were significantly associated with abundance (p-value<0.05). After p-value correction, 2/547 (0.4%) variables were associated with GBS abundance: an increased abundance of GBS was associated with a decreased frequency since last dental checkup (p<0.001) and last dental cleaning (p<0.001). Increased GBS abundance was significantly associated with increased frequency of iron consumption (p=0.007) after p-value correction in multivariate models. Conclusions GBS is found in stool samples from adults in Wisconsin at similar frequencies as pregnant individuals screened with rectovaginal swabs. We did not find associations between risk factors historically associated with GBS in pregnant people, suggesting that risk factors for GBS carriage in pregnancy may differ from those in the general population. We found that frequency of iron consumption and dental hygiene are risk factors for GBS carriage in Wisconsin adults. Given that these variables were not assayed in previous GBS surveys, it is possible they also influence carriage in pregnant people. Taken together, this work serves as a foundation for future work in developing approaches to decrease GBS abundance in carriers.
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Affiliation(s)
- Elise S. Cowley
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Ibrahim Zuniga Chaves
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Fauzia Osman
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison
| | | | - Andrew J. Hryckowian
- Department of Medical Microbiology & Immunology, University of Wisconsin-Madison
- Department of Medicine (Division of Gastroenterology & Hepatology), School of Medicine and Public Health, University of Wisconsin-Madison
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