Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance
Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP)...
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| Published in: | JAMA pediatrics Vol. 173; no. 3; p. 224 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.03.2019
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| ISSN: | 2168-6211, 2168-6211 |
| Online Access: | Get more information |
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| Abstract | Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development.
To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development.
This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018.
Group B Streptococcus isolated from a normally sterile site.
Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance.
The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally.
The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention. |
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| AbstractList | Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development.ImportanceInvasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development.To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development.ObjectiveTo describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development.This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018.Design, Setting, and ParticipantsThis study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018.Group B Streptococcus isolated from a normally sterile site.ExposuresGroup B Streptococcus isolated from a normally sterile site.Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance.Main Outcomes and MeasuresEarly-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance.The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally.ResultsThe Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally.The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention.Conclusions and RelevanceThe rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention. Invasive disease owing to group B Streptococcus (GBS) remains an important cause of illness and death among infants younger than 90 days in the United States, despite declines in early-onset disease (EOD; with onset at 0-6 days of life) that are attributed to intrapartum antibiotic prophylaxis (IAP). Maternal vaccines to prevent infant GBS disease are currently under development. To describe incidence rates, case characteristics, antimicrobial resistance, and serotype distribution of EOD and late-onset disease (LOD; with onset at 7-89 days of life) in the United States from 2006 to 2015 to inform IAP guidelines and vaccine development. This study used active population-based and laboratory-based surveillance for invasive GBS disease conducted through Active Bacterial Core surveillance in selected counties of 10 states across the United States. Residents of Active Bacterial Core surveillance areas who were younger than 90 days and had invasive GBS disease in 2006 to 2015 were included. Data were analyzed from December 2017 to April 2018. Group B Streptococcus isolated from a normally sterile site. Early-onset disease and LOD incidence rates and associated GBS serotypes and antimicrobial resistance. The Active Bacterial Core surveillance program identified 1277 cases of EOD and 1387 cases of LOD. From 2006 to 2015, EOD incidence declined significantly from 0.37 to 0.23 per 1000 live births (P < .001), and LOD rates remained stable (mean, 0.31 per 1000 live births). Among the mothers of 1277 infants with EOD, 617 (48.3%) had no indications for IAP and did not receive it, and 278 (21.8%) failed to receive IAP despite having indications. Serotype data were available for 1743 of 1897 patients (91.3%) from 7 sites that collect GBS isolates. Among patients with EOD, serotypes Ia (242 [27.3%]) and III (242 [27.3%]) were most common. Among patients with LOD, serotype III was most common (481 [56.2%]), and this increased from 2006 to 2015 from 0.12 to 0.20 cases per 1000 live births (P < .001). Serotype IV caused 53 cases (6.2%) of EOD and LOD combined. The 6 most common serotypes (Ia, Ib, II, III, IV, and V) caused 881 EOD cases (99.3%) and 853 LOD cases (99.7%). No β-lactam resistance was identified; 359 isolates (20.8%) tested showed constitutive clindamycin resistance. In 2015, an estimated 840 EOD cases and 1265 LOD cases occurred nationally. The rates of LOD among US infants are now higher than EOD rates. Combined with addressing IAP implementation gaps, an effective vaccine covering the most common serotypes might further reduce EOD rates and help prevent LOD, for which there is no current public health intervention. |
| Author | Farley, Monica M Lynfield, Ruth Harrison, Lee H Apostol, Mirasol Spina, Nancy L Nanduri, Srinivas Acharya Schaffner, William Schrag, Stephanie J Jain, Jennifer H Burzlaff, Kari Pondo, Tracy Vagnone, Paula S Beall, Bernard W Petit, Susan Dufort, Elizabeth M Alden, Nisha B McGee, Lesley Thomas, Ann R Smelser, Chad |
| Author_xml | – sequence: 1 givenname: Srinivas Acharya surname: Nanduri fullname: Nanduri, Srinivas Acharya organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 2 givenname: Susan surname: Petit fullname: Petit, Susan organization: Connecticut Department of Public Health, Hartford – sequence: 3 givenname: Chad surname: Smelser fullname: Smelser, Chad organization: New Mexico Department of Public Health, Santa Fe – sequence: 4 givenname: Mirasol surname: Apostol fullname: Apostol, Mirasol organization: California Emerging Infections Program, Oakland – sequence: 5 givenname: Nisha B surname: Alden fullname: Alden, Nisha B organization: Colorado Department of Public Health and Environment, Denver – sequence: 6 givenname: Lee H surname: Harrison fullname: Harrison, Lee H organization: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland – sequence: 7 givenname: Ruth surname: Lynfield fullname: Lynfield, Ruth organization: Minnesota Department of Health, St Paul – sequence: 8 givenname: Paula S surname: Vagnone fullname: Vagnone, Paula S organization: Minnesota Department of Health, St Paul – sequence: 9 givenname: Kari surname: Burzlaff fullname: Burzlaff, Kari organization: New York State Department of Health, Albany – sequence: 10 givenname: Nancy L surname: Spina fullname: Spina, Nancy L organization: New York State Department of Health, Albany – sequence: 11 givenname: Elizabeth M surname: Dufort fullname: Dufort, Elizabeth M organization: New York State Department of Health, Albany – sequence: 12 givenname: William surname: Schaffner fullname: Schaffner, William organization: Vanderbilt University School of Medicine, Nashville, Tennessee – sequence: 13 givenname: Ann R surname: Thomas fullname: Thomas, Ann R organization: Oregon Department of Human Services, Portland – sequence: 14 givenname: Monica M surname: Farley fullname: Farley, Monica M organization: Atlanta VA Medical Center, Atlanta, Georgia – sequence: 15 givenname: Jennifer H surname: Jain fullname: Jain, Jennifer H organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 16 givenname: Tracy surname: Pondo fullname: Pondo, Tracy organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 17 givenname: Lesley surname: McGee fullname: McGee, Lesley organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 18 givenname: Bernard W surname: Beall fullname: Beall, Bernard W organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia – sequence: 19 givenname: Stephanie J surname: Schrag fullname: Schrag, Stephanie J organization: Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30640366$$D View this record in MEDLINE/PubMed |
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| References | 30830159 - JAMA Pediatr. 2019 Mar 1;173(3):296. doi: 10.1001/jamapediatrics.2019.0061. 30985896 - JAMA Pediatr. 2019 May 1;173(5):502. doi: 10.1001/jamapediatrics.2019.0953. 30640370 - JAMA Pediatr. 2019 Mar 1;173(3):219-220. doi: 10.1001/jamapediatrics.2018.4824. |
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| Title | Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance |
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