Strategies to reduce invasive neonatal Group B Streptococcal disease in Malaysia

Abstract

Invasive neonatal Group B streptococcal (GBS) disease is a globally recognised serious condition. Its most devastating impact is during perinatal and postnatal periods. Epidemiological studies from high-income countries (HICs) showed that maternal rectovaginal GBS colonisation is the leading cause. It was estimated that world-wide, there were 20 million pregnant women with rectovaginal GBS colonisation which has caused 46,200 stillbirths, 40,500 cases of invasive maternal diseases, and 231,800 cases of early-onset and 162,200 cases of late-onset sepsis in neonates/infants. Among neonates/infants who have recovered from the disease, 37,100 suffered neurodevelopmental impairment. The current preventive measures in HICs consist of universal screening for maternal rectovaginal GBS colonisation at 35- to 37-week gestation, followed by intrapartum antibiotic prophylaxis for positive cases. This has prevented more than 80% of early-onset GBS disease. In Malaysian public hospitals, only targeted screening for maternal GBS colonisation was practiced in high-risk women with previous perinatal GBS infection/disease. We do not have national data on a) maternal GBS rectovaginal colonisation rates, b) stillbirths caused by GBS infections, c) preterm birth associated with maternal GBS colonisation, and d) neurodevelopmental impairment following invasive neonatal GBS disease. We only have national data of neonatal GBS sepsis which showed high morbidity and mortality. To reduce invasive neonatal GBS disease in Malaysia, we need national data on the prevalence of maternal GBS rectovaginal colonisation, its associated risk with stillbirths, and GBS-associated preterm births to help improve current preventive strategies to reduce invasive GBS disease during the perinatal and postnatal periods.