15 Jan Group B Streptococcus Remain Significant Threat to US Infants
MedicalResearch.com Interview with:
Dr. Srinivas Acharya Nanduri, MBBS, MD, MPH
Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA 3033
MedicalResearch.com: What is the background for this study?
Response: Group B Streptococcus (GBS) is a leading cause of serious illness such as meningitis and sepsis in infants. Among infants, there are two main types of GBS disease. Early-onset GBS disease occurs during the first week of life and late-onset GBS disease occurs from the first week through three months of life. Rates of early-onset disease in the United States have decreased significantly since the 1990s through widespread implementation of intrapartum antibiotic prophylaxis (IAP) guidelines. However, IAP does not prevent late-onset disease. Maternal immunization represents a nonantibiotic strategy to prevent both early and late-onset disease. Multivalent polysaccharide-protein conjugate vaccines are under development against GBS capsular types, with candidate vaccines in phase I and II trials.
Active Bacterial Core surveillance (ABCs) conducts active surveillance for early and late-onset GBS disease among infants in select counties of 10 states, covering about 10% of live births across the United States. We analyzed data from early and late-onset GBS cases identified from ABCs between 2006 and 2015 to describe their epidemiology, incidence trends, and associated strain characteristics.
MedicalResearch.com: What are the main findings?
Response: From 2006 to 2015, early-onset GBS disease incidence declined significantly from 0.37 to 0.23 per 1000 live births, and late-onset GBS disease incidence remained stable around an average of 0.31 per 1000 live births. In 2015, an estimated 840 cases of early-onset GBS disease and 1265 cases of late-onset GBS disease occurred nationally. While we did not identify any isolates with resistance to beta-lactam antibiotics, there was an increase in proportion of isolates resistant to clindamycin noted from 2006 to 2015. There was a notable increase in late-onset Group B Streptococcus disease owing to serotype III. Whole-genome sequencing data were available for isolates from 2015 and showed that 78.2% of the serotype III late-onset Group B Streptococcus disease isolates belonged to a globally dominant multilocus sequence type ST17. The six most common serotypes (Ia, Ib, II, III, IV and V) were responsible for 99.3% of early-onset GBS disease and 99.7% of late-onset GBS disease.
MedicalResearch.com: What should readers take away from your report?
Response: Despite significant declines in early-onset Group B Streptococcus disease attributed to IAP, the burden of early- and late-onset Group B Streptococcus disease in the United States remains substantial. With late-onset GBS disease rates higher than early-onset GBS disease rates, greater than half of all infant GBS disease in the United States is not preventable by any currently available strategy. A safe and efficacious maternal vaccine against the most common serotypes holds promise to prevent a substantial portion of this remaining burden of GBS disease among infants.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Continued microbiological surveillance for emergence of resistance to beta-lactam antibiotics and for monitoring increasing clindamycin resistance remains critical for early identification of emerging threats to the effectiveness of treatment and prevention strategies. With candidate maternal Group B Streptococcus vaccines in advanced stages of development, surveillance to monitor disease trends wi
Nanduri SA, Petit S, Smelser C, et al. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr. Published online January 14, 2019. doi:10.1001/jamapediatrics.2018.4826
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