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Published on: November 16, 2016
Early-onset group B streptococcal disease in the United States: potential for further reduction
Jennifer R Verani1, Nancy L Spina, Ruth Lynfield
1Centers for Disease Control and Prevention, the Georgia Emerging Infections Program/Atlanta VA Medical Center, and the Georgia Department of Community Health, Atlanta, Georgia; the Emerging Infections Program, New York State Department of Health, Albany, New York; the Minnesota Department of Health, St. Paul, Minnesota; Vanderbilt University School of Medicine, Nashville, Tennessee; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the University of New Mexico, Albuquerque, New Mexico; the Colorado Department of Public Health and Environment, Denver, Colorado; the Connecticut Department of Public Health, Hartford, Connecticut; the Oregon Public Health Division, Portland, Oregon; and the California Emerging Infections Program, Oakland, California.
Insights
Lapses in group B streptococcus (GBS) prevention guidelines occurred in over half of early-onset GBS disease cases. Improving intrapartum antibiotic prophylaxis offers the greatest potential for reducing GBS disease burden.
Area of Science:
- Neonatal Health
- Infectious Disease Prevention
- Public Health Surveillance
Background:
- Group B Streptococcus (GBS) remains a significant cause of early-onset neonatal disease.
- Current prevention strategies rely on prenatal screening and intrapartum antibiotic prophylaxis.
- Adherence to GBS prevention guidelines is crucial for reducing neonatal morbidity and mortality.
Purpose of the Study:
- To identify lapses in adherence to GBS prevention guidelines in early-onset GBS disease cases.
- To estimate the potential reduction in GBS disease burden with optimal prevention implementation.
- To inform strategies for enhancing GBS disease prevention in neonates.
Main Methods:
- Retrospective review of labor, delivery, and prenatal records for neonates with early-onset GBS disease.
- Interviews with prenatal care providers regarding GBS screening practices.
- Evaluation of errors in screening, laboratory methods, communication, and intrapartum prophylaxis.
- Estimation of potential case reduction using published data on screening sensitivity and prophylaxis effectiveness.
Main Results:
- Over half (57.9%) of 309 GBS cases had at least one implementation error.
- Prenatal screening errors were most common in term neonates (36.0%), while intrapartum prophylaxis errors predominated in preterm neonates (54.1%).
- Optimal implementation could reduce GBS cases by 26-59%, with improved intrapartum prophylaxis yielding a 16% decrease.
Conclusions:
- Current GBS prevention strategies can be further optimized, particularly through improved intrapartum antibiotic prophylaxis.
- Even with perfect adherence, the reduction in GBS cases may be limited, highlighting the need for novel approaches.
- Development of improved intrapartum assays and vaccines is essential for further reducing the burden of early-onset GBS disease.
Objective:
To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies.
Methods:
We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008-2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation.
Results:
Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26-59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease).
Conclusion:
Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed.
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