Early-Onset Group B Streptococcal Disease in the United States: Potential for Further Reduction

Verani, Jennifer R. MD; Spina, Nancy L. MPH; Lynfield, Ruth MD; Schaffner, William MD; Harrison, Lee H. MD; Holst, Amy MPH; Thomas, Stepy MSPH; Garcia, Jessica M. MPH; Scherzinger, Karen MS; Aragon, Deborah MSPH; Petit, Susan MPH; Thompson, Jamie MPH; Pasutti, Lauren MPH; Carey, Roberta PhD; McGee, Lesley PhD; Weston, Emily MPH; Schrag, Stephanie J. DPhil

doi: 10.1097/AOG.0000000000000163
Contents: Original Research

OBJECTIVE: To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies.

METHODS: We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008–2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation.

RESULTS: Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26–59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease).

CONCLUSION: Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed.

LEVEL OF EVIDENCE: II

Further reduction of early-onset group B streptococcal disease burden is possible under current strategies; however, because potential declines are modest, novel prevention approaches are needed.

Centers for Disease Control and Prevention, the Georgia Emerging Infections Program/Atlanta VA Medical Center, and the Georgia Department of Community Health, Atlanta, Georgia; the Emerging Infections Program, New York State Department of Health, Albany, New York; the Minnesota Department of Health, St. Paul, Minnesota; Vanderbilt University School of Medicine, Nashville, Tennessee; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the University of New Mexico, Albuquerque, New Mexico; the Colorado Department of Public Health and Environment, Denver, Colorado; the Connecticut Department of Public Health, Hartford, Connecticut; the Oregon Public Health Division, Portland, Oregon; and the California Emerging Infections Program, Oakland, California.

Corresponding author: Jennifer R. Verani, MD, MPH, 1600 Clifton Road, MS-C25, Atlanta, GA 30307; e-mail: jverani@cdc.gov.

The authors thank the following individuals for their assistance with study design, data collection, data entry, contributions, or all to the Active Bacterial Core surveillance system: Heather Altier, Mirasol Apostol, Kathryn Arnold, Brenda G. Barnes, Wendy Baughman, Amanda Feldpausch, Carmen Ford-Treacy, Ryan Gierke, Corinne Holtzman, Jillian Karr, Gayle Langley, Catherine Lexau, Lauren Lorentzson, Amy Peterson, Arthur Reingold, Jennifer Sadlowski, Karen Stefonek, Glenda Smith, Hilary Stevens, Ann Thomas, Karrie-Ann Toews, Chris Van Beneden, Ben White, and Carolyn Wright.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.