TY - JOUR
T1 - Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide
T2 - Systematic Review and Meta-analyses
AU - Madrid, Lola
AU - Seale, Anna C.
AU - Kohli-Lynch, Maya
AU - Edmond, Karen M.
AU - Lawn, Joy E.
AU - Heath, Paul T.
AU - Madhi, Shabir A.
AU - Baker, Carol J.
AU - Bartlett, Linda
AU - Cutland, Clare
AU - Gravett, Michael G.
AU - Ip, Margaret
AU - Le Doare, Kirsty
AU - Rubens, Craig E.
AU - Saha, Samir K.
AU - Sobanjo-Ter Meulen, Ajoke
AU - Vekemans, Johan
AU - Schrag, Stephanie
N1 - Funding Information:
Financial support. This supplement was supported by a grant to the London School of Hygiene & Tropical Medicine from the Bill & Melinda Gates Foundation (reference number OPP1131158).
Funding Information:
Potential conflicts of interest. Many contributors to this series of papers have received funding for their research from foundations, especially the Bill & Melinda Gates Foundation, and several from the Wellcome Trust, Medical Research Council UK, the Thrasher Foundation, the Meningitis Research Foundation, and one individual from the US National Institutes of Health. Members of the Expert Advisory Group received reimbursement for travel expenses to attend working meetings related to this series. A. S.-t. M. works for the Bill & Melinda Gates Foundation. C. J. B. has served as a member of the Presidential Advisory Committee for Seqirus Inc and of the CureVac Inc Scientific Advisory Committee, as well as undertaken consultancy work for Pfizer Inc. C. C. has received institutional compensation from Novartis for conducting GBS studies. P. T. H. has been a consultant to Novartis and Pfizer on GBS vaccines but received no funding for these activities. M. I. has undertaken sponsored research from Pfizer on pneumococcal disease in adults and from Belpharma Eumedica (Belgium) on temocillin antimicrobial susceptibility in Enterobacteriaceae. K. L. D. has received funding by the Bill & Melinda Gates Foundation to work on research on GBS serocorrelates of protection to inform vaccine trials, and travel expenses from Pfizer to attend a meeting on an investigator-led project on GBS. S. A. M. has collaborated on GBS grants funded by GlaxoSmithKline and by Pfizer and received personal fees for being member of its advisory committee; he has also collaborated on a GBS grant funded by Minervax. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
PY - 2017
Y1 - 2017
N2 - Background. Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates. Methods. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0-89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence. Results. We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI],.43-.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI,.36-.47); late-onset disease incidence was 0.26 (95% CI,.21-.30). CFR was 8.4% (95% CI, 6.6%-10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V. Conclusions. The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.
AB - Background. Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates. Methods. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0-89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence. Results. We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI],.43-.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI,.36-.47); late-onset disease incidence was 0.26 (95% CI,.21-.30). CFR was 8.4% (95% CI, 6.6%-10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V. Conclusions. The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.
KW - case fatality risk
KW - early onset
KW - estimate
KW - group B Streptococcus
KW - late onset
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U2 - 10.1093/cid/cix656
DO - 10.1093/cid/cix656
M3 - Review article
C2 - 29117326
AN - SCOPUS:85034221638
SN - 1058-4838
VL - 65
SP - S160-S172
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -