Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children

Anna C. Seale, Fiorella Bianchi-Jassir, Neal J. Russell, Maya Kohli-Lynch, Cally J. Tann, Jenny Hall, Lola Madrid, Hannah Blencowe, Simon Cousens, Carol J. Baker, Linda Bartlett, Clare Cutland, Michael G. Gravett, Paul T. Heath, Margaret Ip, Kirsty Le Doare, Shabir A. Madhi, Craig E. Rubens, Samir K. Saha, Stephanie J. SchragAjoke Sobanjo-Ter Meulen, Johan Vekemans, Joy E. Lawn

Research output: Contribution to journalArticle

Abstract

We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. Methods. For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. Results. Worldwide in 2015, we estimated 205 000 (uncertainty range [UR], 101 000-327 000) infants with early-onset disease and 114 000 (UR, 44 000-326 000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19 000) presented with neonatal encephalopathy. There were 90 000 (UR, 36 000-169 000) deaths in infants <3 months age, and, at least 10 000 (UR, 3 000-27 000) children with disability each year. There were 33 000 (UR, 13 000-52 000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12 000-104 000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107 000 (UR, 20 000-198 000) stillbirths and infant deaths. Conclusions. Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409 000 (UR, 144 000-573 000) maternal/fetal/infant cases and 147 000 (UR, 47 000-273 000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.

Original languageEnglish (US)
Pages (from-to)S200-S219
JournalClinical Infectious Diseases
Volume65
DOIs
StatePublished - Jan 1 2017

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Stillbirth
Streptococcus agalactiae
Uncertainty
Pregnant Women
Mothers
Vaccines
Premature Birth
Brain Diseases
Postpartum Period
Infection
Maternal Exposure
Fetal Death
Antibiotic Prophylaxis
Disabled Children
Live Birth
Fetus
Odds Ratio
Newborn Infant

Keywords

  • group B Streptococcus
  • infection
  • maternal
  • newborn
  • stillbirth

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Seale, A. C., Bianchi-Jassir, F., Russell, N. J., Kohli-Lynch, M., Tann, C. J., Hall, J., ... Lawn, J. E. (2017). Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. Clinical Infectious Diseases, 65, S200-S219. https://doi.org/10.1093/cid/cix664

Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. / Seale, Anna C.; Bianchi-Jassir, Fiorella; Russell, Neal J.; Kohli-Lynch, Maya; Tann, Cally J.; Hall, Jenny; Madrid, Lola; Blencowe, Hannah; Cousens, Simon; Baker, Carol J.; Bartlett, Linda; Cutland, Clare; Gravett, Michael G.; Heath, Paul T.; Ip, Margaret; Le Doare, Kirsty; Madhi, Shabir A.; Rubens, Craig E.; Saha, Samir K.; Schrag, Stephanie J.; Sobanjo-Ter Meulen, Ajoke; Vekemans, Johan; Lawn, Joy E.

In: Clinical Infectious Diseases, Vol. 65, 01.01.2017, p. S200-S219.

Research output: Contribution to journalArticle

Seale, AC, Bianchi-Jassir, F, Russell, NJ, Kohli-Lynch, M, Tann, CJ, Hall, J, Madrid, L, Blencowe, H, Cousens, S, Baker, CJ, Bartlett, L, Cutland, C, Gravett, MG, Heath, PT, Ip, M, Le Doare, K, Madhi, SA, Rubens, CE, Saha, SK, Schrag, SJ, Sobanjo-Ter Meulen, A, Vekemans, J & Lawn, JE 2017, 'Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children', Clinical Infectious Diseases, vol. 65, pp. S200-S219. https://doi.org/10.1093/cid/cix664
Seale, Anna C. ; Bianchi-Jassir, Fiorella ; Russell, Neal J. ; Kohli-Lynch, Maya ; Tann, Cally J. ; Hall, Jenny ; Madrid, Lola ; Blencowe, Hannah ; Cousens, Simon ; Baker, Carol J. ; Bartlett, Linda ; Cutland, Clare ; Gravett, Michael G. ; Heath, Paul T. ; Ip, Margaret ; Le Doare, Kirsty ; Madhi, Shabir A. ; Rubens, Craig E. ; Saha, Samir K. ; Schrag, Stephanie J. ; Sobanjo-Ter Meulen, Ajoke ; Vekemans, Johan ; Lawn, Joy E. / Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. In: Clinical Infectious Diseases. 2017 ; Vol. 65. pp. S200-S219.
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T1 - Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children

AU - Seale, Anna C.

AU - Bianchi-Jassir, Fiorella

AU - Russell, Neal J.

AU - Kohli-Lynch, Maya

AU - Tann, Cally J.

AU - Hall, Jenny

AU - Madrid, Lola

AU - Blencowe, Hannah

AU - Cousens, Simon

AU - Baker, Carol J.

AU - Bartlett, Linda

AU - Cutland, Clare

AU - Gravett, Michael G.

AU - Heath, Paul T.

AU - Ip, Margaret

AU - Le Doare, Kirsty

AU - Madhi, Shabir A.

AU - Rubens, Craig E.

AU - Saha, Samir K.

AU - Schrag, Stephanie J.

AU - Sobanjo-Ter Meulen, Ajoke

AU - Vekemans, Johan

AU - Lawn, Joy E.

PY - 2017/1/1

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N2 - We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. Methods. For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. Results. Worldwide in 2015, we estimated 205 000 (uncertainty range [UR], 101 000-327 000) infants with early-onset disease and 114 000 (UR, 44 000-326 000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19 000) presented with neonatal encephalopathy. There were 90 000 (UR, 36 000-169 000) deaths in infants <3 months age, and, at least 10 000 (UR, 3 000-27 000) children with disability each year. There were 33 000 (UR, 13 000-52 000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12 000-104 000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107 000 (UR, 20 000-198 000) stillbirths and infant deaths. Conclusions. Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409 000 (UR, 144 000-573 000) maternal/fetal/infant cases and 147 000 (UR, 47 000-273 000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.

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KW - group B Streptococcus

KW - infection

KW - maternal

KW - newborn

KW - stillbirth

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