Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children
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Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children
Anna C. Seale 12 13
Fiorella Bianchi-Jassir 13
Neal J. Russell 10 13
Maya Kohli-Lynch 13 18
Cally J. Tann 13 17
Jenny Hall 16
Lola Madrid 13 15
Hannah Blencowe 13
Simon Cousens 13
Carol J. Baker 20
Linda Bartlett 19
Clare Cutland 14
Michael G. Gravett 7 8
Paul T. Heath 5
Margaret Ip 6
Kirsty Le Doare 3 5
Shabir A. Madhi 4 14
Craig E. Rubens 1 7
Samir K. Saha 2
Stephanie J. Schrag 0
Ajoke Sobanjo-ter Meulen 11
Johan Vekemans 9
Joy E. Lawn 13
0 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
1 Department of Global Health, University of Washington , Seattle , USA
2 Bangladesh Institute of Child Health , Dhaka
3 Centre for International Child Health, Imperial College London , United Kingdom
4 National Institute for Communicable Diseases, National Health Laboratory Service , Johannesburg , South Africa
5 Vaccine Institute, Institute for Infection and Immunity, St George's University of London and St George's University Hospitals NHS Foundation Trust , United Kingdom
6 Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
7 Global Alliance to Prevent Prematurity and Stillbirth, Seattle , Washington , USA
8 Department of Obstetrics and Gynecology, University of Washington School of Medicine , Seattle , USA
9 World Health Organization , Geneva , Switzerland
10 King's College London , United Kingdom
11 Bill & Melinda Gates Foundation, Seattle , Washington , USA
12 College of Health and Medical Sciences, Haramaya University , Dire Dawa , Ethiopia
13 Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine , United Kingdom
14 Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
15 ISGlobal, Barcelona Centre for International Health Research, Hospital Clinic, University of Barcelona , Spain
16 Department of Reproductive Health Research, University College London Institute for Women's Health , United Kingdom
17 Neonatal Medicine, University College London Hospitals NHS Foundation Trust , United Kingdom
18 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol , United Kingdom
19 Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA
20 Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine , Houston, Texas , USA
Background. We aimed to provide the first comprehensive estimates of the burden of group B Streptococcus (GBS), including invasive disease in pregnant and postpartum women, fetal infection/stillbirth, and infants. Intrapartum antibiotic prophylaxis is the current mainstay of prevention, reducing early-onset infant disease in high-income contexts. Maternal GBS vaccines are in development. Methods. For 2015 live births, we used a compartmental model to estimate (1) exposure to maternal GBS colonization, (2) cases of infant invasive GBS disease, (3) deaths, and (4) disabilities. We applied incidence or prevalence data to estimate cases of maternal and fetal infection/stillbirth, and infants with invasive GBS disease presenting with neonatal encephalopathy. We applied risk ratios to estimate numbers of preterm births attributable to GBS. Uncertainty was also estimated. Results. Worldwide in 2015, we estimated 205 000 (uncertainty range [UR], 101 000-327 000) infants with early-onset disease and 114 000 (UR, 44 000-326 000) with late-onset disease, of whom a minimum of 7000 (UR, 0-19 000) presented with neonatal encephalopathy. There were 90000 (UR, 36 000-169 000) deaths in infants <3 months age, and, at least 10 000 (UR, 3 000-27 000) children with disability each year. There were 33000 (UR, 13 000-52 000) cases of invasive GBS disease in pregnant or postpartum women, and 57 000 (UR, 12 000-104 000) fetal infections/stillbirths. Up to 3.5 million preterm births may be attributable to GBS. Africa accounted for 54% of estimated cases and 65% of all fetal/infant deaths. A maternal vaccine with 80% efficacy and 90% coverage could prevent 107 000 (UR, 20 000-198 000) stillbirths and infant deaths. Conclusions. Our conservative estimates suggest that GBS is a leading contributor to adverse maternal and newborn outcomes, with at least 409 000 (UR, 144 000-573 000) maternal/fetal/infant cases and 147 000 (UR, 47 000-273 000) stillbirths and infant deaths annually. An effective GBS vaccine could reduce disease in the mother, the fetus, and the infant.
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The number of worldwide child deaths has declined, from
an estimated 12.7 million in 1990 to 5.9 million in 2015 [
1
].
However, there has been less progres (...truncated)