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Prevalence, Serotype Distribution and Mortality Risk Associated With Group B Streptococcus Colonization of Newborns in Rural Bangladesh

Islam, Mohammad Shahidul MSPH; Saha, Samir K. PhD; Islam, Maksuda BA; Modak, Joyanta K. MS; Shah, Rashed DrPH; Talukder, Radwanur R. MBBS; El Arifeen, Shams DrPH; Baqui, Abdullah H. DrPH; Darmstadt, Gary L. MD; Mullany, Luke C. PhD

The Pediatric Infectious Disease Journal: December 2016 - Volume 35 - Issue 12 - p 1309–1312
doi: 10.1097/INF.0000000000001306
Original Studies

Background: Group B Streptococcus (GBS) is a predominant cause of early-onset neonatal sepsis globally; however, the impact of this organism on the health of newborns in South Asia is debated, due in part to a paucity of community-based assessments. We estimated the prevalence and serotypes of GBS colonization of the umbilical cord stump and the association of colonization with mortality in a population-based cohort of newborns in rural Sylhet District, Bangladesh.

Methods: Umbilical cord swabs were collected from 646 newborns up to 3 times within the first week after birth (ages <24 hours, ~3 days, ~6 days) and processed to identify GBS serotypes.

Results: GBS was isolated from 6.3% (41/646) of newborns. Sixty-one percent of the GBS colonization occurred in neonates within 24 hours of delivery. Serotypes VII (37.1%, n = 13/36) and Ia (33.3%, n = 12/36) were the most predominant colonizing GBS isolates. Other detected serotypes were Ib (11.1%, n = 4/36), II (11.1%, n = 4/36), V (5.6%, n = 2/36) and VI (2.8%, n = 1/36). Mortality risk among newborns with GBS colonization was 6.6 (95% confidence interval: 2.1–20.4) times higher than for those without GBS.

Conclusions: The overall prevalence of GBS colonization was lower than in settings, where GBS is a predominant etiology of neonatal illness. In addition, the GBS serotype distribution differed from that reported in the developed part of the world. However, further studies are needed to understand the true burden of GBS-related illness. Mortality risk was substantially increased in the presence of GBS on the umbilical stump, providing support for chlorhexidine antisepsis to the cord to prevent colonization of invasive pathogens.

From the *Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh; International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Global Health, Save the Children USA, Washington DC; §Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

Accepted for publication May 26, 2016.

Supported by a grant from the Thrasher Research Fund (#02875-5). The larger chlorhexidine trial was supported by the United States Agency for International Development (USAID), through cooperative agreements (GHS-A-00-03-00019-00, GHS-A-00-09-00004-00) with the Johns Hopkins Bloomberg School of Public Health and by the Saving Newborn Lives program of Save the Children US through a grant (#131) from the Bill and Melinda Gates Foundation.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Samir K. Saha, PhD, Department of Microbiology, Dhaka Shishu Hospital, Sher-e-Bangla Nagar, Dhaka-1207, Bangladesh. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.