Journal
CLINICAL INFECTIOUS DISEASES
Volume 74, Issue -, Pages S14-S23Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciab793
Keywords
Group B streptococcus; GBS; neurodevelopment impairment; outcomes; mortality
Categories
Funding
- Bill & Melinda Gates Foundation [NV-009018, OPP1126780]
- LSHTM [2836]
- EDCTP [2836]
- government of Mozambique
- Spanish Agency for International Development
- Spanish Ministry of Science and Innovation through the Centro de Excelencia Severo Ochoa 2019-2023 program [CEX2018-000806-S]
- Generalitat de Catalunya through the CERCA program
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Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). A study conducted in Mozambique found that iGBS remains a significant cause of perinatal and infant disease and death, and surviving GBS exposes infants to an increased risk of long-term neurodevelopmental sequelae, highlighting the importance of maternal GBS vaccination strategies.
Background Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). We present data on iGBS from 2 decades of surveillance in Manhica, Mozambique, with a focus on NDI. Methods Morbidity surveillance databases in a rural Mozambican district hospital were screened for iGBS cases. From February 2020 to March 2021, surviving iGBS patients (n = 39) plus age- and sex-matched children without iGBS (n = 119) were assessed for neurocognitive development, vision, and hearing. The role of GBS in stillbirths and infant deaths was investigated using minimally invasive tissue sampling (MITS). Results Ninety iGBS cases were included, with most children being <3 months of age (85/90). The in-hospital case fatality rate was 14.4% (13/90), increasing to 17.8% (3 additional deaths) when considering mortality during the 6 months postdiagnosis. Fifty percent of the iGBS exposed infants and 10% of those unexposed showed any NDI. Surviving GBS conferred a 11-fold increased adjusted odds of moderate/severe NDI (odds ratio, 2.8 [95% confidence interval, .92-129.74]; P = .06) in children aged 0-5 years. For older children (6-18 years), no differences in NDI were found between exposed and unexposed. Motor domain was the most affected among young GBS survivors. Three stillbirths and 4 early neonatal deaths (of the 179 MITS performed) were attributed to iGBS. Conclusions In absence of preventive strategies, such as intrapartum antibiotics, iGBS remains a significant cause of perinatal and infant disease and death. GBS also causes major longer-term neurodevelopmental sequelae, altogether justifying the need for maternal GBS vaccination strategies to increase perinatal and infant survival.
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