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Group B Strep infection causes estimated 150,000 stillbirth and infant death

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An estimated one in five pregnant women around the world carry Group B Streptococcus (GBS) bacteria, according to a study on the major, yet preventable, cause of maternal and infant ill health.

The findings should now spur the development of a vaccine, said the research team from around the world, which has just published a series of 11 papers on the issue.

“Too many parents around the world face the death of a baby”

Joy Lawn

Out of 410,000 GBS cases every year, there will be at least 147,000 stillbirths and infant deaths globally, according to research led by the London School of Hygiene and Tropical Medicine.

Despite being home to only 13% of the world’s population, they found Africa had the highest burden, with 54% of estimated cases and 65% of stillbirths and infant deaths.

It includes data and estimates for the year 2015 from every country of the world, including outcomes for pregnant women, their babies and infants.

The research found GBS was present among pregnant women in all world regions, with an average of 18% colonised with the bacteria – ranging from 11% in eastern Asia to 35% in the Caribbean.

The top five countries by numbers of pregnant women colonised were: India (2,466,500) China (1,934,900), Nigeria (1,060,000), United States of America (942,800) and Indonesia (799,100).

Current GBS prevention focuses on giving antibiotics to women in labour, aiming to reduce disease in infants at delivery.

But the researchers argued that 231,000 infant and maternal GBS cases could potentially be prevented if a vaccine was made available, that was 80% effective and reached 90% of women.

If untreated, GBS can cause serious infections, such as meningitis and septicaemia, which may lead to stillbirths, and newborn and infant deaths. If they survive, babies can develop permanent problems including hearing or vision loss, or cerebral palsy.

The research series represents the first comprehensive study of the burden of GBS and is funded by a grant from the Bill & Melinda Gates Foundation.

Dr Keith Klugman, director of the pneumonia team at the foundation, said: “By filling in one of the great voids in public health data, this work provides crucial insight.

“Immunizing expectant mothers is a potentially ground-breaking approach that could dramatically reduce the number of maternal and child deaths,” he said.

“It is now essential to accelerate the GBS vaccine development activities”

Johan Vekemans

Series co-lead Joy Lawn, professor of maternal, reproductive and child health at the London School of Hygiene and Tropical Medicine, said: “Too many parents around the world face the death of a baby or a young child – avoidable GBS deaths are happening in every country.

“Antibiotics currently prevent an estimated 29,000 cases of early-onset Group B Streptococcal disease per year, almost all in high-income settings,” she said. “[But] giving antibiotics to 21.7 million women may contribute to antimicrobial resistance – a major global health crisis.”

Study co-author Johan Vekemans, medical officer of the Initiative for Vaccine Research at the World Health Organization, said: “It is now essential to accelerate the GBS vaccine development activities.

“The technical feasibility is estimated to be high,” he said. “Next steps include a comprehensive evaluation of cost-effectiveness.”

The research is published in the journal Clinical Infectious Diseases, and also being presented at the American Society of Tropical Medicine and Hygiene’s annual meeting in Baltimore.

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