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Group B Streptococcal Disease in England (1998 - 2017): A Population-based Observational Study.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Kadambari, Seilesh 
Trotter, Caroline L 
Heath, Paul T 
Goldacre, Michael J 
Pollard, Andrew J 

Abstract

BACKGROUND AND OBJECTIVES: Group B Streptococcus (GBS) is the leading cause of sepsis and meningitis in infants <90 days. In this study, the burden of GBS disease and mortality in young infants in England was assessed. METHODS: Using linked hospitalization records from every National Health Service (NHS) hospital from April 1, 1998 to March 31, 2017, we calculated annual GBS incidence in infants aged <90 days and, using regression models, compared their perinatal factors, rates of hospital-recorded disease outcomes, and all-cause infant mortality rates with those of the general infant population. RESULTS: 15 429 infants aged <90 days had a hospital-recorded diagnosis of GBS, giving an average annual incidence of 1.28 per 1000 live births (95% CI 1.26-1.30) with no significant trend over time. GBS-attributable mortality declined significantly from 0.044 (95% CI .029-.065) per 1000 live births in 2001 to 0.014 (95% CI .010-.026) in 2017 (annual percentage change -6.6, 95% CI -9.1 to -4.0). Infants with GBS had higher relative rates of visual impairment (HR 7.0 95% CI 4.1-12.1), cerebral palsy (HR 9.3 95% CI 6.6-13.3), hydrocephalus (HR 17.3 95% CI 13.8-21.6), and necrotizing enterocolitis (HR 18.8 95% CI 16.7-21.2) compared with those without GBS. CONCLUSIONS: Annual rates of GBS disease in infants have not changed over 19 years. The reduction in mortality is likely multifactorial and due to widespread implementation of antibiotics in at-risk mothers and babies, as well as advances in managing acutely unwell infants. New methods for prevention, such as maternal vaccination, must be prioritized.

Description

Keywords

Group B Streptococcus, clinical burden, epidemiology, mortality, England, Female, Humans, Incidence, Infant, Infant, Newborn, Pregnancy, Sepsis, State Medicine, Streptococcal Infections, Streptococcus agalactiae

Journal Title

Clin Infect Dis

Conference Name

Journal ISSN

1058-4838
1537-6591

Volume Title

72

Publisher

Oxford University Press (OUP)

Rights

All rights reserved