Group B streptococcal carriage in Nigeria

1038 patients of different age groups and clinical conditions attending three large hospitals in Ibadan between August 1977 and December 1978 were screened for group B streptococcal carriage. 132 (12.7%) of these patients were found to be colonized by this organism. A breakdown of the colonization rates was: in women--19.3% during the first and second trimesters of pregnancy, 17.6% during labour (third trimester) and 19% among STD patients; in adult males--9% among STD patients and nil among patients without STD; in newborns--4.7%. Type III was found most frequently (56.1%)) and there was a high incidence of R and X strains and of strains with only Ic protein. Type Ia streptococci were sensitive to penicillin G, ampicillin, erythromycin and cephalothin. Only 74.2% of the strains were sensitive to tetracycline.     

Hospital-based policies for prevention perinatal Group B streptococcal disease--United States, 1999

Group B streptococcus (GBS) is the leading cause of sepsis, meningitis, and pneumonia in newborns in the United States (1). Because intrapartum prophylactic antibiotics reduce mother-to-child GBS transmission (2), in 1996, CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics recommended that hospitals adopt formal GBS prevention policies (2-4). From 1994 to 1997, the proportion of hospitals with formal intrapartum GBS prevention policies increased from 39% to 59% (5,6); hospitals that implemented policies reported less GBS disease among neonates (7). In 1999, CDC's Active Bacterial Core Surveillance (ABCs) system surveyed hospitals in eight states about their GBS prevention policies. This report summarizes the results of that analysis and indicates that in 1999, the proportion of hospitals with formal policies had not changed since 1997; however, a higher proportion of hospitals have implemented measures to improve policy compliance.     

Potential cost-effectiveness of a maternal Group B streptococcal vaccine in The Gambia

ObjectiveTo estimate neonatal health benefits and healthcare provider costs of a theoretical Group B streptococcal (GBS) hexavalent maternal vaccination programme in The Gambia, a low-income setting in West Africa.MethodsA static decision analytic cost-effectiveness model was developed from the healthcare provider perspective. Demographic data and acute care costs were available from studies in The Gambia undertaken in 2012–2015. Further model parameters were taken from United Nations and World Health Organisation sources, supplemented by data from a global systematic review of GBS and literature searches. As vaccine efficacy is not known, we simulated vaccine efficacy estimates of 50–90%. Costs are reported in US dollars. Cost-effectiveness thresholds of one (US$473, very cost effective) and three (US$1420, cost effective) times Gambian GDP were used.ResultsVaccination with a hexavalent vaccine would avert 24 GBS disease cases (55%) and 768 disability adjusted life years compared to current standard of care (no interventions to prevent GBS disease). At vaccine efficacy of 70%, the programme is cost-effective at a maximum vaccine price per dose of 12 US$ (2016 US$), and very cost-effective at a maximum of $3/dose. The total costs of vaccination at $12 is $1,056,962 for one annual cohort of Gambian pregnant women. One-way sensitivity analysis showed that GBS incidence was the most influential parameter on the cost effectiveness ratio.ConclusionThe introduction of a hexavalent vaccine would considerably reduce the current burden of GBS disease in The Gambia but to be cost-effective, the vaccine price per dose would need to be $12/dose or less.     

Group G streptococcal purulent pericarditis. A case report

We report one of the first two cases of group G streptococcal purulent pericarditis in the medical literature. Our experience illustrates that outcome for patients with this serious group G streptococcal infection may be poor. Failure of single-drug antibiotic therapy can occur, and we conclude that aggressive drainage and combination antibiotics are the most appropriate response to this potentially fatal infection.     

Neonatal Group B streptococcal infection at the Mount Hope Women's Hospital, Trinidad

OBJECTIVE: To determine the incidence of early onset Group B streptococcal (GBS) infection in neonates at the Mount Hope Women's Hospital, Trinidad over the period 1996-97. DESIGN AND METHODS: This retrospective study included all babies with a positive blood culture for GBS during the study period. RESULTS: There were 9866 live births (LB) of whom 29 were diagnosed as early onset GBS disease. The incidence was 2.9/1000 LB. 37.9% of babies were preterm and 65.5% were delivered to primiparous women. Rupture of amniotic membranes occurred within 12 h of delivery in 55% of infected babies. Four of the 29 infected babies died and all were preterm. CONCLUSION: The incidence of early onset neonatal GBS sepsis was five to six times higher in this series than that reported in the USA and UK. An intervention policy to control this preventable disease is urgently needed.     

Control of neonatal group B streptococcal infection.

Group B beta-haemolytic streptococcus (GBS) is the leading cause of life-threatening perinatal infection in developed countries. As immunization of women is not yet available, selective intrapartum chemoprophylaxis appears to be the best current strategy for preventing disease. All pregnant women should be screened for GBS at 26 to 28 weeks gestation. During labour, all colonized women with risk factors for invasive GBS neonatal infection should be treated with intravenous penicillin or ampicillin. Risk factors include preterm labour, premature rupture of membranes, intrapartum fever, multiple births, prolonged rupture of membranes, maternal diabetes, previous sibling with invasive GBS disease, and maternal GBS bacteriuria. The latter two categories warrant chemoprophylaxis regardless of maternal colonization status.     

Group G streptococcal bacteremia in Jerusalem

Group G Streptococcus (GGS) can cause severe infections, including bacteremia. These organisms often express a surface protein homologous to the Streptococcus pyogenes M protein. We retrospectively studied the characteristics of patients from the Hadassah Medical Center with GGS bacteremia from 1989 to 2000. Ninety-four cases of GGS bacteremia were identified in 84 patients. The median age was 62 years, 54% were males, and 92% had underlying diseases (35% had a malignancy, and 35% had diabetes mellitus). The most frequent source for bacteremia was cellulitis (61%). emm typing of 56 available isolates disclosed 13 different types, including 2 novel types. Six patients had recurrent bacteremia with two to four bacteremic episodes, five had chronic lymphatic disorders, and two had emm type stG840.0 in every episode. Recurrent bacteremia has not been described for invasive group A Streptococcus. We describe an entity of recurrent GGS bacteremia, which is associated with lymphatic disorders and possibly with emm stG840.0.     

Group B streptococcal conjugate vaccines elicit functional antibodies independent of strain O-acetylation

Recently, it was discovered that sialic acid residues on group B streptococcal (GBS) capsular polysaccharides (CPS) are O-acetylated. Since GBS vaccine development has focused on de-O-acetylated CPS, it became germane to investigate the influence of de-O-acetylated GBS vaccine formulations on functional activity of sera against strains that bear the O-acetyl modification. Post-immunization sera from healthy adult recipients of de-O-acetylated GBS CPS-tetanus toxoid conjugate vaccines were evaluated in opsonophagocytosis assays using 20 GBS clinical isolates representing type Ia, Ib, II, III, or V CPS that varied in amount of O-acetylation from 2% to 40%. Ninety percent or greater opsonophagocytosis and killing of all strains were achieved, using CPS type-specific post-immunization sera. These data indicate that de-O-acetylated CPS-conjugate vaccines contain immunogenic epitopes that offer protection against GBS, independent of O-acetyl CPS modifications. Thus, presence of O-acetyl groups on the GBS CPS is not essential for functional antibodies to be elicited by GBS glycoconjugate vaccines.     

Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system.

Group B streptococcal (GBS) disease is the most common cause of neonatal sepsis and meningitis in the United States. It is also an important cause of morbidity among pregnant women and adults with underlying medical conditions. Because most states have not designated GBS disease as a reportable condition, previous estimates of the incidence of GBS disease were based on studies from single hospitals or small geographic areas. This report summarizes the results of population-based active surveillance for invasive GBS disease in counties within four states that had an aggregate population of 10.1 million persons in 1990. A case of GBS disease was defined as isolation of group B streptococcus from a normally sterile anatomic site in a resident of one of the surveillance areas. Age- and race-adjusted projections to the U.S. population suggest that > 15,000 cases and > 1,300 deaths due to GBS disease occur each year. The projected age- and race-adjusted national incidence is 1.8/1,000 live births for neonatal GBS disease and 4.0/100,000 population per year for adult GBS disease. Intrapartum chemoprophylaxis for pregnant women at risk for delivering infants with GBS disease is the most effective strategy available for prevention of neonatal disease. Development of effective GBS vaccines may prevent GBS disease in both infants and adults. Ongoing surveillance for GBS disease is important for targeting preventive measures and determining their effectiveness.     

Group L beta-haemolytic streptococcal infection in meat handlers: another streptococcal zoonosis?

Group L, beta-haemolytic streptococci can cause infection in dogs, pigs, cattle and sheep but there have been very few reports in man. In studies of skin infection in meat handlers we cultured group L streptococci from clinically infected wounds, impetigo and paronychia of 15 patients involved in the slaughter and processing of chickens and pigs. Staphylococcus aureus was also present in eight (53%) of the lesions. At least five other infections with group L streptococci in meat and animal handlers are known to have occurred in other parts of England in recent years, and brief details are given.