Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)

Abstract

Background: Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS).

Methods: Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death.

Results: We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48).

Conclusions: Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.

Keywords: Streptococcus agalactiae; death in 24 hours; early neonatal death, stillbirth; minimally invasive tissue sampling (MITS).

Figure 1.

(A) Number of deaths enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS), stratified by age group and by whether Group B Streptococcus (GBS) was detected and determined by DeCoDe assessment to be in the causal pathway to death, detected but not in causal pathway, and not detected. (B) GBS-detected cases stratified by age at death (in days) and by causal pathway. Note: there were 4 postneonatal deaths for which GBS was detected and determined to be in the causal pathway; ages at death were 57, 128, 426, and 698 days. SB, stillbirth.

Figure 2.

Clinical syndromes caused by Group B Streptococcus (GBS) among deaths attributed to GBS (n = 79).

Figure 3.

Infectious and noninfectious causes of death by age group among deaths in which Group B Streptococcus was detected by diagnostic testing but was not determined to be in the causal pathway to death by Determination of Cause of Death panel review. HIV, human immunodeficiency virus.