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. 2018 Jan 19;13(1):e0191193.
doi: 10.1371/journal.pone.0191193. eCollection 2018.

Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015

Betuel Sigaúque  1   2 , Miwako Kobayashi  3 , Delfino Vubil  1 , Ariel Nhacolo  1 , Alberto Chaúque  1 , Benild Moaine  1 , Sérgio Massora  1 , Inácio Mandomando  1 , Tacilta Nhampossa  1 , Quique Bassat  1   4 , Fabiana Pimenta  3 , Clara Menéndez  1   4   5 , Maria da Gloria Carvalho  3 , Eusebio Macete  1 , Stephanie J Schrag  3
Affiliations

Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015

Betuel Sigaúque et al. PLoS One. .

Abstract

Background: Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001-2015, with a focus on GBS epidemiology and strain characteristics.

Methods: Community-level birth and mortality data were obtained from Manhiça's demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhiça district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing.

Results: There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (≥0.12 μg/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone.

Conclusion: A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies.

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Conflict of interest statement

Competing Interests: Dr. Betuel Sigaúque currently works for John Snow, Inc. with the Maternal and Child Survival Program in Mozambique. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Summary of young infants aged <90 days admitted for invasive bacterial disease, Manhiça demographic and health surveillance system, Mozambique, 2001–2015.
Fig 2
Fig 2. Trends of invasive bacterial disease and neonatal mortality rates (per 1,000 live births) during 2001–2015 and stillbirth rate (per 1,000 births) during 2001–2013, Manhiça, Mozambique.
Fig 3
Fig 3. Trends of invasive GBS disease incidence rates in young infants (<90 days), Manhiça, 2001–2015.
See this image and copyright information in PMC

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