Journal Article

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

Kohli-Lynch, Maya, O’Sullivan, Catherine, Edmond, Karen M, Le Doare, Kirsty, Lawn, Joy E, Madhi, Shabir A, Berkley, James A, Hammoud, Majeda, Heath, Paul T, Kobayahsi, Miwako, Saha, Samir K, Rubens, Craig E, Tyrrell, Greg, Agarwal, Ramesh, Sakata, Hiro, Sigaúque, Betuel, Vekemans, Johan, Dhaded, Sangappa, Bartlett, Linda, Paul, Vinod, Sridhar, Santhanam, Seale, Anna C, Baker, Carol J, Cutland, Clare, Gravett, Michael G, Schrag, Stephanie, Sobanjo-ter Meulen, Ajoke, Bassat, Quique, da Silva, Andre Ricardo Araujo, Madrid, Lola, Dangor, Ziyaad, Ip, Margaret, Giannoni, Eric

2017

Overview

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Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0-89 days.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.

• Publisher: Oxford University Press
• Subject: Age / Antibiotics / Babies / Bacterial infections / Children / Confidence intervals / Estreptococs / Global Health - statistics & numerical data / Gram-positive bacteria / Health risks / 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