Vaccines for maternal immunization against Group B Streptococcus disease: WHO perspectives on case ascertainment and case definitions

Abstract

Group B Streptococcus (GBS) is an important cause of disease in young infants, stillbirths, pregnant and post-partum women. GBS vaccines for maternal immunization are in development aiming to reduce this burden. Standardisation of case definitions and ascertainment methodologies for GBS disease is needed to support future trials of maternal GBS vaccines. Considerations presented here may also serve to promote consistency in observational studies and surveillance, to better establish disease burden. The World Health Organization convened a working group to provide consensus guidance for case ascertainment and case definitions of GBS disease in stillbirths, infants, pregnant and post-partum women, with feedback sought from external stakeholders. In intervention studies, case capture and case ascertainment for GBS disease should be based on antenatal recruitment of women, with active follow-up, systematic clinical assessment, standardised sampling strategies and optimised laboratory methods. Confirmed cases of invasive GBS disease in stillbirths or infants should be included in a primary composite endpoint for vaccine efficacy studies, with GBS cultured from a usually sterile body site (may be post-mortem). For additional endpoints, or observational studies, confirmed cases of GBS sepsis in pregnant and post-partum women should be assessed. Culture independent diagnostic tests (CIDTs) may detect additional presumed cases, however, the use of these diagnostics needs further evaluation. Efficacy of vaccination against maternal and neonatal GBS colonisation, and maternal GBS urinary tract infection could be included as additional, separate, endpoints and/or in observational studies. Whilst the focus here is on specific GBS disease outcomes, intervention studies also present an opportunity to establish the contribution of GBS across adverse perinatal outcomes, including all-cause stillbirth, preterm birth and neonatal encephalopathy.

Keywords: Case ascertainment; Case definition; Group B; Streptococcus agalactiae; Vaccine.

Fig. 1

Case ascertainment of invasive GBS disease in pregnant and post-partum women, stillbirths and infants (0–89 days). pSBI = possible serious bacterial infection; CIDT = culture independent diagnostic tests. *Unless clinical contraindication. **GBS isolates should be stored, to allow later typing, ideally using whole genome sequencing. # Dependent on establishment of specificity of the particular CIDT (based on nuclei acid amplification) used. ## Blood, cerebrospinal fluid and lung should be prioritised for sampling.