Group B Streptococcus Remain Significant Threat to US Infants

MedicalResearch.com Interview with:

Dr. Nanduri Srinivas Acharya, MBBS, MD, MPH Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Roybal Campus Atlanta, GA 30333

Dr. Nanduri

Dr. Srinivas Acharya Nanduri, MBBS, MD, MPH
Respiratory Diseases Branch, National Center for Immunizations and Respiratory Diseases
Centers for Disease Control and Prevention
Roybal Campus
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

No disclosures. 

Citation:

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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