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Group B Streptococcus

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Colonizes the genital tract; risk groups include: ... Invasive group B streptococcal infections may manifest as any of several ... – PowerPoint PPT presentation

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Title: Group B Streptococcus


1
Group B Streptococcus
  • Streptococcus agalactiae

2
GBS Epidemiology
  • Colonizes the genital tract risk groups include
  • Infants Colonization during delivery may
    results in invasive disease
  • Pregnant and post-partum women
  • Non-pregnant adults
  • Elderly
  • Individuals with chronic underlying disease

3
Burden of Invasive GBS Disease, 1989-1990,
Atlanta NEJM, 1993 3281807
4
Age Distribution of GBS in Infants and Neonates
Clin Microbiol Rev, 1998 11497.
5
Incidence of Invasive GBS Disease with Age,
1989-1990, Atlanta NEJM, 1993 3281807
6
Risk Factors for Early Onset Group B
Streptococcal Disease BMJ, 2002 325308
7
1996 Recommendations (CDC) MMWR, 1996 45(No.
RR-7)
  • Prenatal GBS screening at 35-37 weeks
  • Offer penicillin intrapartum if
  • GBS ()
  • Culture not done and risk factors present
  • Previous infant had IGBS disease
  • Mother had GBS bacteriuria, this pregnancy
  • Delivery occurred at
  • Risk factor screening
  • Offer penicillin intrapartum if
  • Previous infant had IGBS disease
  • Mother had GBS bacteriuria, this pregnancy
  • Delivery occurred at
  • Duration of ruptured membranes 18 hours
  • Intrapartum temperature 100.4F

8
Reduction in IGBS Disease Emerg Infect Dis,
2001 792
9
Population-based Comparison of Strategies to
Prevent Early-Onset GBS NEJM, 2002 347233
10
2002 Recommendations (CDC) MMWR, 2002 51(No.
RR-11)
  • Universal screening of all women at 35-37 weeks
    gestation
  • Prophylax
  • Previous infant with IGBS
  • GBS bacteriuria this pregnancy
  • Positive GBS screen this pregnancy unless
  • C-section planned in the absence of labor or
    rupture of membranes
  • Unknown GBS status AND delivery at rupture of membranes 18 hours, or intrapartum
    temperature 100.4 F

11
Vaccine Arch Dis Child, 2003 88375-8
  • Phase I trial completed
  • Women at 32-34 weeks
  • Serum antibody and cord blood antibody
  • Elevated after immunization
  • Promoted killing of GBS in vitro
  • May protect against both late and early onset
    disease
  • Barriers
  • Pharmaceutical leadership / liability issues

12
GBS Clinical Presentation
  • Neonates
  • Sepsis, meningitis, pneumonia, cellulitis,
    osteomyelitis, septic arthritis
  • Pregnant and post-partum women
  • Mild UTI, sepsis less commonly osteomyelitis,
    endocarditis, meningitis
  • Non-pregnant adults
  • Bacteremia, skin or soft tissue infections
    pneumonia urosepsis endocarditis
    peritonitis meningitis empyema

13
IGBS Case Definition (draft)
  • Clinical description
  • Invasive group B streptococcal infections may
    manifest as any of several clinical syndromes,
    including pneumonia, deep soft-tissue infection,
    meningitis, peritonitis, osteomyelitis, septic
    arthritis, postpartum sepsis (i.e., puerperal
    fever), neonatal sepsis, and nonfocal bacteremia.

14
IGBS Case Definition (draft)
  • Laboratory criteria for diagnosis
  • Isolation of group B Streptococcus (Streptococcus
    agalactiae) by culture from a normally sterile
    site (e.g., blood or cerebrospinal fluid, or,
    less commonly, joint, pleural, or pericardial
    fluid)
  • Case classification
  • Confirmed a case that is laboratory confirmed

15
Public Health Action
  • Case ascertainment
  • Case investigation
  • Fill out yellow card and CDC meningitis form
  • Follow up early onset disease (onset age) to determine if mother was
    cultured/prophylaxed.

16
GBS - Summary
  • Important pathogen of
  • Newborns
  • Pregnant and post-partum women
  • Non-pregnant adults with underlying disease
  • Vaccine in development
  • Investigation
  • Demographics, site of infection, source of
    isolate (establish baseline incidence before
    vaccine licensure)
  • Follow-up of early-onset disease
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