Group B Strep Awareness Month

What is Group B Strep?

Many people have never heard of Group B Streptococcus (GBS, Strep B or group B Strep), yet it is one of the earliest and most dangerous health threats infants can face. GBS is a normal bacterium carried by 20-30% of adults.[1] It is normally harmless to the carrier, however it can be unknowingly passed from mother to baby in the womb or around birth, and cause stillbirth, infant death or disability.

Why is it important to raise awareness of Group B Strep?

GBS infection is the leading cause of sepsis and meningitis in babies under 3 months. Tragically, many families first hear about Strep B after their baby has become seriously ill with Strep B meningitis, sepsis or pneumonia.

Around the world, there are an estimated 320,000 GBS infections in babies a year. 90,000 babies die and another 10,000 survive with moderate to severe disability.[2] The highest incidence of GBS is reported in East and South Africa. 54% of global GBS cases are reported on the African continent, and 65% of GBS-associated stillbirths and infant deaths.[3]

A global average estimate indicates that approximately 1 in 4 babies with GBS infection will die globally.[4] This varies between countries, and the level of medical facilities available. In middle to high-income countries, it can be as low as 1 in 20.

Up to 50% of the babies who recover from GBS meningitis will have long-term after-effects [5] that may include:

• Cerebral palsy

• Hearing loss

• Sight loss

• Learning difficulties

What can be done and what are the issues?

The good news is that many of these infections in newborns can be prevented – simply, safely and cheaply. Antibiotics – ideally penicillin – given in labour to women who are carrying the bacteria will prevent as much as 90% of these infections developing in newborn babies.[6]

However, public awareness of GBS, testing procedures and treatments are sometimes very limited. Research conducted in Saudi Arabia[7] showed that the majority of pregnant women in the study (66.8%) were not aware of GBS at all.

Knowledge gaps amongst medical professionals is also a concern. In South Africa, a study of 238 participants found that most doctors (68.0%) and nurses (94.3%) could not correctly list a single risk factor for GBS infection in a newborn baby. A third of doctors also did not know the correct antibiotic protocols for the mother.[8]

Additionally, in many countries, like the UK, GBS testing is not routinely offered to all pregnant women, provided instead on a conditional basis. In the UK, expectant mothers are offered tests if they carried GBS in a previous pregnancy and the baby was not infected. Instead of offering intravenous antibiotics in labour based on the results of antenatal tests, the UK only these certain risk factors arise, including:

• Women who have previously had a baby who developed GBS infection

• Women in preterm labour

• Women with a fever in labour

• Women where GBS has been identified during the current (or sometimes previous) pregnancy

An additional risk factor for a newborn baby developing GBS infection is where the woman’s waters have broken a long time before the baby is born and this risk factor will prompt the offer of the antibiotics in labour in some countries, though not the UK.

Despite introducing this risk-factor based testing protocol, the incidence of GBS infections in the UK has increased by 19%.[9] In comparison, after universal testing was introduced in the United States, the rate of early-onset group B Strep infection dropped by over 80%.[10] A meta-analysis of studies found that a universal screening policy was associate with lower risk of early-onset GBS disease, when compared either with risk-based protocols, or with no policy.[11]

What is being done?