Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses

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 diseas...

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Bibliographic Details
Published in:Clinical infectious diseases 2017-11, Vol.65 (suppl_2), p.S160-S172
Main Authors: Madrid, Lola, Seale, Anna C, Kohli-Lynch, Maya, Edmond, Karen M, Lawn, Joy E, Heath, Paul T, Madhi, Shabir A, Baker, Carol J, Bartlett, Linda, Cutland, Clare, Gravett, Michael G, Ip, Margaret, Le Doare, Kirsty, Rubens, Craig E, Saha, Samir K, Sobanjo-Ter Meulen, Ajoke, Vekemans, Johan, Schrag, Stephanie
Format: Article
Language:English
Subjects:
Age
Antibiotics
Babies
Bacterial infections
Children
Confidence intervals
Estreptococs
Global Health - statistics & numerical data
Gram-positive bacteria
Humans
Incidence
Infant, Newborn
Infant, Newborn, Diseases - epidemiology
Infant, Newborn, Diseases - etiology
Infant, Newborn, Diseases - microbiology
Infant, Newborn, Diseases - prevention & control
Infants
Information systems
Literature reviews
Neonates
Prophylaxis
Risk Factors
Sepsis
Serogroup
Serotypes
Streptococcal Infections - epidemiology
Streptococcus
Streptococcus agalactiae - classification
Streptococcus infections
The Burden of Group B Streptococcus Worldwide for Pregnant Women, Stillbirths, and Children
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Summary: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. 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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0-89 days.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. 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. 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.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cix656