ArticlesGroup B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis
Introduction
Group B streptococcus (Streptococcus agalactiae) is the most common cause of neonatal sepsis in high-income countries.1, 2 Disease risk is highest during the first 3 months of life and declines substantially thereafter. Early-onset disease (day 0–6) is the result of vertical transmission from a colonised mother during or just before delivery.3 Late-onset disease (day 7–89) can be acquired from the mother or from environmental sources.4, 5 Case fatality from both early-onset and late-onset disease is high, even with antibiotic therapy.2, 3 Group B streptococcus is also an important cause of preterm delivery, antepartum and intrapartum stillbirth, and puerperal sepsis.6, 7
Prevention of early-onset group B streptococcus has become a realistic option, through the use of intrapartum antibiotics given to pregnant women with risk factors or known carriage of the bacteria (intrapartum antibiotic prophylaxis).8, 9, 10 This prophylaxis has been implemented in most high-income countries since the late 1990s, but has been difficult to implement in many low-income countries and middle-income countries.11, 12, 13 Several group B streptococcus vaccines are also at various stages of testing and could allow prevention of both early-onset disease and late-onset disease.6, 14 However, many challenges exist to obtaining accurate estimates of disease burden, especially for low-income and middle-income countries, including difficulties with obtaining specimens and poor laboratory capacity for diagnosis of group B streptococcus.
We aimed to estimate the incidence of group B streptococcal invasive disease and case fatality in infants aged 0–89 days in the era of intrapartum prophylaxis, estimate the incidence of early and late onset invasive disease, and estimate distribution of group B streptococcal serotypes in invasive disease specimens. Secondary objectives were to assess how the incidence of group B streptococcus varies with gross national income (GNI) per head and geographical region.
Section snippets
Definitions and classification
We defined invasive group B streptococcal disease as laboratory isolation of Streptococcus agalactiae from a normally sterile site in an infant aged 0–89 days with any signs of clinical disease (eg, sepsis, pneumonia, or meningitis).
Search strategy and selection criteria
We searched Medline, Embase, and Wholis databases using the search terms (“Streptococcus agalactiae”[Mesh] OR “Streptococcus Group B” OR “Group B Streptococcal”) AND Limits: Humans, Publication date 2000/01/01–2011/09/01. We restricted our search from January 2000,
Results
2709 papers were identified from the Medline and Wholis search from Jan 1, 2000, to Sept 1, 2011, and 423 titles were retained. No additional articles were obtained from the Embase search, 111 titles were obtained from the concurrent WHO Global Burden of Disease neonatal-infection search, and 114 titles were obtained from experts in neonatal care and reference lists. No unpublished data that met our inclusion criteria were identified. 74 papers were retained after the abstracts were reviewed
Discussion
More studies are needed to accurately estimate the global burden of group B streptococcus, especially in low-income countries. We judge our overall estimate of group B streptococcus incidence (0·53 per 1000 livebirths) to be an underestimate of the global incidence. Incidence and case fatality were two-times higher in infants who had group B streptococcal disease in the first week of life (0–6 days) compared with later infancy (7–89 days). The disease is often rapidly fulminating and many cases
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