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?
Developing Vaccines
There is currently no vaccine to prevent GBS, however various trials for vaccines are in development. [12] A vaccine against GBS would have huge benefits, preventing more GBS infections than antibiotics can, as well as reducing the use of antibiotics.
The World Health Organization (WHO) has turned its focus in recent years on group B Strep, including the development of a GBS Vaccine Development Technology Roadmap. Read more about preventing meningitis here.
Unlike other methods of prevention, a vaccine would also have the potential to prevent not only early-onset GBS infections, but also late onset infections, miscarriages, stillbirths, preterm births, and maternal infections caused by GBS.
Evaluating and Improving Policies and Practices: the GBS3 Trial
Beyond increasing awareness of GBS and supporting families affected, the UK organisation Group B Strep Support also advocates for the introduction of routine testing, following the successful introduction of such programmes in other countries. A new trial, funded by the National Institute for Health Research, has begun in the UK this year. It will look at the effectiveness of different testing methods (one testing women late in pregnancy, and the other testing women in labour) compared with the UK’s risk-based approach. The results will inform the future of pregnancy care and screening for GBS, potentially saving lives. The trial has been temporarily delayed due to the Covid-19 pandemic, however it will resume as soon as it is safe to do so. Read more about the GBS3 Trial.
Global Road Map to Defeat Meningitis by 2030
The Global Road Map to Defeat Meningitis by 2030, a World Health Organisation initiative, driven by the Meningitis Research Foundation, is reflective of the voices of survivors, impacted families and advocates. Together, we are calling on governments to acknowledge the personal, emotional and financial burden of meningitis worldwide. Enough is enough and change is possible.
The proportion of meningitis survivors with severe after-effects is highest from GBS infection (32%) than when meningitis is caused by any other organism. Without defeating GBS, it is not possible to defeat meningitis.
In recognition of the harm caused by GBS infection, the Global Road Map outlines key strategic goals in reducing the incidence of GBS worldwide. To summarise these points:
By 2030 all countries will have implemented a policy for GBS screening in pregnant women, as well as antibiotic protocols, unless a GBS vaccination programme is available.
There are currently no global guidelines for GBS disease surveillance. A key goal outlined in the Road Map is to develop guidance and implementation of GBS disease surveillance, as well as after-effects.
Show your support for the Global Road Map by signing this pledge. Everyone has a different reason why they want to defeat meningitis – what’s yours?
What can I do?
Get involved with GBSS’s Strep B Awareness Month 2020 #StrepB2020 – visit the website for more information, and follow them on social media as they share information, videos and families’ stories throughout July.
"Knowledge about group B Strep saves little lives. When families know about Strep B, and know what the key risks and signs are, they can take steps to protect their baby. Make sure those you and your networks are fully informed." Says Jane Plumb MBE, Chief Executive and co-founder of GBSS.
“We’re very excited to be releasing a series of new videos during July, and to launch the new online learning module for members of the UK’s Royal College of Midwives – if you’re a member, do take this free course.
“We co-wrote a longer course with Microbirth School, which for a relatively small fee is available to everyone – find out more here."
To learn more:
About Strep B Awareness Month
About Group B Strep Support
About the GBS3 Trial
References