Cited by 511Neonatal and Maternal InfectionsStreptococcal Infections and TreatmentsBacterial Infections and Vaccines

Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children

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Seale, Anna C, Bianchi-Jassir, Fiorella, Russell, Neal J, Kohli-Lynch, Maya, Tann, Cally J, Hall, Jenny, Madrid, Lola, Blencowe, Hannah +15 more·2017·Clinical Infectious Diseases

Abstract

BACKGROUND: We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. METHODS: For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. RESULTS: Worldwide in 2015, we estimated 205000 (uncertainty range [UR], 101000-327000) infants with early-onset disease and 114000 (UR, 44000-326000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19000) presented with neonatal encephalopathy. There were 90000 (UR, 36000-169000) deaths in infants <3 months age, and, at least 10000 (UR, 3000-27000) children with disability each year. There were 33000 (UR, 13000-52000) cases of invasive GBS disease in pregnant or postpartum women, and 57000 (UR, 12000-104000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107000 (UR, 20000-198000) stillbirths and infant deaths. CONCLUSIONS: Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409000 (UR, 144000-573000) maternal/fetal/infant cases and 147000 (UR, 47000-273000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.

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  • It has been estimated that group B S. agalactiae could cause between 114,000-204,000 invasive cases and 147,000 still births and infant deaths every year worldwide.

    “It has been estimated that group B S. agalactiae could cause between 114,000–204,000 invasive cases and 147,000 still births and infant deaths every year worldwide [86].”

    From Global etiology of bacterial meningitis: A systematic review and meta-analysis. (2018) · cites this paper as [86]

    Table 6 in the Discussion estimates 57,000 stillbirths and 90,000 infant deaths worldwide, which sum to the claimed 147,000. But the Results (Step 2) estimate 319,000 infant invasive GBS cases worldwide; 114,000 late-onset and approximately 205,000 early-onset cases are separate estimates, not the endpoints of a 114,000–204,000 range. (LLM, conf=0.91)

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  1. [55]Pfizer. Press release: Pfizer awarded grant to evaluate vaccine to protect newborns against group B Streptococcus infection. Available at: http://www.pfizer.com/news/press-release/press-release-detail/pfizer_awarded_grant_to_evaluate_vaccine_to_protect_newborns_against_group_b_streptococcus_infection-0. Accessed 24 March 2017.

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Authors
Seale, A. C., Bianchi-Jassir, F., Russell, N. J., Kohli-Lynch, M., Tann, C. J., Hall, J., Madrid, L., Blencowe, H., Cousens, S., Baker, C. J., Bartlett, L., Cutland, C., Gravett, M. G., Heath, P. T., Ip, M., Le Doare, K., Madhi, S. A., Rubens, C. E., Saha, S. K., Schrag, S. J., Sobanjo-ter Meulen, A., Vekemans, J., & Lawn, J. E.
Affiliations
  • Haramaya University (ET)
  • London School of Hygiene & Tropical Medicine (GB)
  • King's College London (GB)
  • University of Bristol (GB)
  • University College London Hospitals NHS Foundation Trust (GB)
  • University College London (GB)
  • Baylor College of Medicine (US)
  • Johns Hopkins University (US)
  • University of the Witwatersrand (ZA)
  • University of Washington (US)
  • St George's, University of London (GB)
  • Chinese University of Hong Kong (HK)
  • Vaccine Institute, Institute for Infection and Immunity, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom;
  • National Health Laboratory Service (ZA)
  • Bangladesh Institute of Child Health, Dhaka;
  • Centers for Disease Control and Prevention (US)
  • Bill & Melinda Gates Foundation, Seattle, Washington; and
  • World Health Organization (CH)
Corresponding author
Seale, Anna C
Venue
Clinical Infectious Diseases
Published
2017-11-06
Volume
65
Issue
suppl_2
Pages
S200-S219
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
OpenAlex
W2767655591
Cited by
511
References
57
Citations by year
2026: 37 · 2025: 54 · 2024: 82 · 2023: 63 · 2022: 63 · 2021: 75 · 2020: 58 · 2019: 46 · 2018: 22 · 2017: 10
FWCI
35.18
Type
journal article
Language
en
Open access
Licence
public-domain
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Greater South Information System
Funders
  • National Institutes of Health
  • Wellcome Trust
  • London School of Hygiene and Tropical Medicine
  • Bill and Melinda Gates Foundation (OPP1131158)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
  • Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Keywords
Streptococcus agalactiae, invasive GBS disease, stillbirth, neonatal infection, early-onset GBS disease, late-onset GBS disease, neonatal encephalopathy, maternal GBS colonization, preterm birth, intrapartum antibiotic prophylaxis, infant mortality, disability, Africa
MeSH terms
Brain Diseases, Female, Humans, Infant, Newborn, Infant, Newborn, Diseases, Pregnancy, Pregnancy Complications, Infectious, Streptococcal Infections, Streptococcus agalactiae, Global Health, Meningitis, Bacterial, Cost of Illness, Stillbirth

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