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Rate of late-onset GBS in infants surpasses early-onset cases
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The rate of early-onset disease caused by group B Streptococcus, or GBS, has decreased among infants in the United States between 2006 and 2015, according to research published in JAMA Pediatrics. Researchers said late-onset disease caused by GBS is now more common in this population, which means efforts to prevent the disease should shift toward vaccine development rather than intrapartum antibiotic prophylaxis.
Srinivas Acharya Nanduri, MBBS, MD, MPH, an epidemiologist in the Respiratory Diseases Branch of the CDC’s National Center for Immunizations and Respiratory Diseases, and colleagues wrote that a portion of disease caused by GBS in the first week of life — or early-onset disease (EOD) — could be prevented by better implementing guideline recommendations for intrapartum antibiotic prophylaxis (IAP). However, the researchers wrote that late-onset disease (LOD) among infants aged 7 to 89 days cannot be prevented by IAP.
“Moreover, more than 30% of infants delivered in the U.S. are now exposed to intrapartum antibiotics, raising concern about potential for emergence of antibiotic resistance in GBS or other neonatal pathogens, as well as unintended consequences from disruption of the establishment of the newborn microbiota,” the researchers added.
Nanduri and colleagues examined EOD and LOD incidence, case characteristics and serotype distribution among infants in the U.S. between 2006 and 2015. Data were collected through active population-based and lab-based surveillance of invasive GBS cases across 10 states.
More cases of LOD (n = 1,387) were observed during the study period than EOD (n = 1,277). The researchers observed a statistically significant decline in EOD cases between 2006 and 2015 — from 0.37 to 0.23 per 1,000 live births (P < .001). LOD rates remained consistent at 0.31 per 1,000 live births.
Among mothers who had children with EOD, nearly half (48.3%) did not have indications for IAP and did not receive it, and 21.8% did not receive IAP despite having indications for it.
Nanduri and colleagues said the most commonly reported serotypes included 1A (27.3%) and 3 (27.3%). Serotype 3 caused 56.2% of LOD cases, with the rate of disease attributable to this serotype increasing from 0.12 cases per 1,000 live births in 2006 to 0.2 cases per 1,000 live births in 2015.
The six most common serotypes — 1A, 1B, 2, 3, 4 and 5 — caused 99.3% of EOD cases and 99.7% of LOD cases. Although no beta-lactam resistance was identified in these isolates, 20.8% demonstrated resistance against clindamycin.
In 2015, an estimated 840 EOD cases and 1,265 LOD cases occurred in the U.S., according to the researchers.
“With LOD rates higher than EOD rates, more than half of all infant GBS disease in the U.S. is not preventable by any currently available strategy,” Nanduri and colleagues wrote. “A safe and efficacious maternal vaccine against the most common serotypes holds promise to prevent a substantial portion of this remaining burden. With candidate vaccines in advanced stages of development, surveillance to monitor disease trends and characteristics provides a key evidence base for vaccine and public health policy decisions.” – by Katherine Bortz
Disclosures: Acharya Nanduri reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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