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Meta-Analysis
. 2017 Nov 6;65(suppl_2):S160-S172.
doi: 10.1093/cid/cix656.

Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses

Lola Madrid  1   2   3 , Anna C Seale  2   4 , Maya Kohli-Lynch  2   5 , Karen M Edmond  6 , Joy E Lawn  2 , Paul T Heath  7 , Shabir A Madhi  8   9 , Carol J Baker  10 , Linda Bartlett  11 , Clare Cutland  8 , Michael G Gravett  12   13 , Margaret Ip  14 , Kirsty Le Doare  7   15 , Craig E Rubens  12   16 , Samir K Saha  17 , Ajoke Sobanjo-Ter Meulen  18 , Johan Vekemans  19 , Stephanie Schrag  20 ; Infant GBS Disease Investigator Group
Collaborators, Affiliations
Meta-Analysis

Infant Group B Streptococcal Disease Incidence and Serotypes Worldwide: Systematic Review and Meta-analyses

Lola Madrid et al. Clin Infect Dis. .

Abstract

Background: Group B Streptococcus (GBS) remains a leading cause of neonatal sepsis in high-income contexts, despite declines due to intrapartum antibiotic prophylaxis (IAP). Recent evidence suggests higher incidence in Africa, where IAP is rare. We investigated the global incidence of infant invasive GBS disease and the associated serotypes, updating previous estimates.

Methods: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data regarding invasive GBS disease in infants aged 0-89 days. We conducted random-effects meta-analyses of incidence, case fatality risk (CFR), and serotype prevalence.

Results: We identified 135 studies with data on incidence (n = 90), CFR (n = 64), or serotype (n = 45). The pooled incidence of invasive GBS disease in infants was 0.49 per 1000 live births (95% confidence interval [CI], .43-.56), and was highest in Africa (1.12) and lowest in Asia (0.30). Early-onset disease incidence was 0.41 (95% CI, .36-.47); late-onset disease incidence was 0.26 (95% CI, .21-.30). CFR was 8.4% (95% CI, 6.6%-10.2%). Serotype III (61.5%) dominated, with 97% of cases caused by serotypes Ia, Ib, II, III, and V.

Conclusions: The incidence of infant GBS disease remains high in some regions, particularly Africa. We likely underestimated incidence in some contexts, due to limitations in case ascertainment and specimen collection and processing. Burden in Asia requires further investigation.

Keywords: case fatality risk; early onset; estimate; group B Streptococcus; late onset.

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Figures

Figure 1.
Figure 1.
Infant group B streptococcal (GBS) disease in disease schema for GBS, as described by Lawn et al [12].
Figure 2.
Figure 2.
Search strategy and process of study selection. Abbreviation: GBS, group B Streptococcus.
Figure 3.
Figure 3.
Worldwide distribution of data inputs. A, Map illustrating number of studies by country reporting incidence of group B streptococcal (GBS) invasive disease. B, Map illustrating overall incidence of GBS disease among infants by country included in the meta-analyses. Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Pooled estimated incidence risk per 1000 live births of overall infant invasive group B streptococcal disease. Abbreviations: CI, confidence interval; ES, effect size; GBS, group B Streptococcus.
Figure 5.
Figure 5.
Global distribution of group B Streptococcus (GBS) serotypes in invasive disease in young infants (N = 6500 isolates). A, Prevalence of GBS serotypes presented as percentage (number of cases). B, Distribution of GBS serotypes by region. Serotypes included in a pentavalent vaccine are shown in blue and those not included are shown in red.
See this image and copyright information in PMC

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