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Updated: Aug 17, 2026
A Murine Model of Group B Streptococcus Vaginal Colonization
Published on: November 16, 2016
Comparison of prevention strategies for neonatal group B streptococcal infection. A population-based economic
J C Mohle-Boetani1, A Schuchat, B D Plikaytis
1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Insights
Preventing neonatal group B streptococcus (GBS) disease with intrapartum antibiotics or maternal vaccination is cost-effective. Alternative strategies to universal screening for GBS colonization should be explored.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Health Economics
Background:
- Intrapartum antibiotics can prevent early-onset neonatal group B streptococcal (GBS) disease, but implementation is hindered by screening challenges and cost uncertainties.
- The development of GBS vaccines presents a new avenue for disease prevention.
Purpose of the Study:
- To evaluate the cost-effectiveness of different strategies for preventing neonatal GBS disease in the United States.
- To compare universal screening with intrapartum antibiotics, targeted antibiotics without screening, and maternal vaccination.
Main Methods:
- A decision analysis model was employed, utilizing cost-effectiveness and cost-benefit analysis.
- Outcomes and costs were compared between no intervention and three prevention strategies: screened intrapartum antibiotics, targeted intrapartum antibiotics, and maternal vaccination.
- Data from multistate population-based surveillance informed the model's estimates of disease impact and costs.
Main Results:
- Screening-based intrapartum antibiotic prophylaxis could prevent ~3300 neonatal GBS cases annually, saving ~$16 million.
- Targeted antibiotics without screening could prevent ~3200 cases, saving ~$66 million, while avoiding logistical issues.
- Maternal vaccination (80% coverage, 80% efficacy) could prevent ~4100 cases annually with ~$131 million in savings.
Conclusions:
- Universal prenatal screening for GBS and chemoprophylaxis is likely cost-beneficial.
- Alternative strategies are needed for populations where GBS screening is impractical.
- Continued development of a GBS vaccine is a public health priority.
Background:
Intrapartum antibiotics can prevent early-onset neonatal group B streptococcal (GBS) disease but have not been widely used. Obstacles include difficulty in implementing screening for GBS colonization and uncertainty about cost-effectiveness. The GBS vaccines for disease prevention are now being developed.
Methods:
We developed a decision analysis model and used standard cost-effectiveness and cost-benefit analysis methods. We compared the outcomes and costs of the recent practice of no intervention with those expected for three prevention strategies: (1) intrapartum antibiotics administered to colonized women with labor complications, (2) an alternative strategy that does not require screening but uses epidemiologic criteria and labor complications to target intrapartum antibiotics, and (3) maternal vaccination. We used data from multistate population-based surveillance to estimate the potential impact of each strategy on disease and costs in the United States.
Results:
Intrapartum antibiotic prophylaxis of high-risk women identified by screening could prevent approximately 3300 cases (47% of neonatal disease) annually in the United States and could save approximately $16 million in direct medical costs. Chemoprophylaxis of high-risk women identified using epidemiologic criteria could potentially be equally effective (3200 cases prevented) and would avoid the logistical difficulties of screening; the net savings would be approximately $66 million. Vaccinating 80% of pregnant women with a vaccine that prevents 80% of cases among infants born at or after 34 weeks of gestation would prevent approximately 4100 neonatal cases annually with a net savings of $131 million.
Conclusions:
Universal prenatal screening for GBS and chemoprophylaxis of colonized women with labor complications is likely to be cost-beneficial in the United States. Development of alternative strategies should be further explored for populations in which GBS screening is impractical. Continued development of a GBS vaccine is an important public health priority.
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