Tragically, many people don’t hear about Group B Streptococcus (GBS, Strep B or group B Strep) until they have personal experience with the disease, often after their baby becomes seriously ill. That’s why Group B Strep Awareness Month every July is so important, helping share potentially life-saving information with others. Whether you’re pregnant, hope to be or know someone else who is or has recently had a baby, knowing the key signs of infection and getting early treatment saves lives.
“It's vital that new and expectant parents are well informed about group B Strep. Most of these infections can be prevented, and for those that can't knowing the key signs of infection and getting early treatment saves lives." - Jane Plumb MBE, Chief Executive of Group B Strep Support
GBS bacteria is very commonplace, being present in the intestines, rectum or vagina of around 11-35% of pregnant people. Colonisation with GBS is commonplace and not a sign of poor health or hygiene. Most people carrying GBS will have no symptoms but it can affect their babies around the time of birth. Anyone at any age can be infected by GBS but we often talk about babies because GBS is the most common cause of serious infection in newborns in some countries. This was recently recognised in the process to create the Roadmap to Defeat Meningitis by 2030, with GBS listed as an important pathogen causing sepsis and meningitis in newborns. Throughout the Roadmap, GBS has been singled out in some goals due to its particularly high incidence in babies, low levels of awareness and the lack of prevention strategies in many countries show we still have a long way to go.
Underappreciated Costs, Long-Term Effects
GBS infection largely affects families at birth but, for so many, it lasts much longer than that. A recent study, published in The Lancet Child & Adolescent Health, analysed the outcomes of surviving GBS infection among nearly 25,000 children born in Denmark and The Netherlands between 1997 and 2017. The results found that there were significant after-effects later in life, with one in 20 survivors experiencing some form of neurodevelopmental disability. Compared to children who did not have GBS infection, children affected were twice as likely to have neurodevelopmental impairments and require special educational support. As the largest study to quantify the long-term effects of GBS infection among babies who survive, it adds on to the findings on the long-term after effects of meningitis. These studies indicate, time and time again, that there are still huge gaps in our knowledge regarding the risks linked to these diseases. Many consequences are subtle and are only evident later in life. Fortunately, GBS is usually treatable and most babies survive with no complications but it’s nevertheless a very scary experience for a family to go through and most of these infections could be prevented. 5-20% of cases do tragically result in death, completely changing people’s lives.
The Barriers to Prevention
In highlighting the long-term effects of GBS infection, the study also demonstrates the limitations of treatment and the importance of prevention. Babies in The Netherlands and Denmark live in high income countries with access to high standards of medical care and nevertheless, many survivors of GBS meningitis and sepsis are affected for the rest of their lives. Vaccine developers have spent the last thirty years trying to develop a vaccine for GBS but a vaccine becoming available in the immediate future is very unlikely. Preventing GBS infection therefore depends on different methods, like adopting a risk-based screening approach or a test-based screening approach. A risk-based approach means giving expectant mothers intravenous antibiotics during labour if their babies are considered at increased risk. There are multiple possible risk factors e.g. preterm labour, fever in labour, the identification of GBS during the current (or previous) pregnancy etc. and what is considered a risk factor may depend on a country’s health guidelines. Unfortunately, this means that some expectant parents are given antibiotics when they don’t actually need them, contributing to antimicrobial resistance. Conversely, it also means that some are missed and not provided with treatment even if they need it. Standard antenatal testing, on the other hand, mean that all pregnant people are tested and are only offered antibiotics if they test positive for GBS. Beyond these strategies, midwives, doctors and expectant parents need to be fully informed about GBS because failure in following-through with the standards set by national guidelines can result in needless suffering.
A report published in February 2021 by UK-based charity Group B Strep Support found considerable barriers to prevention; nearly 90% of hospitals are not using the gold-standard test for GBS carriage that significantly decreases the likelihood of false negative results and 51% of Trusts did not give all pregnant people information on GBS. England does not offer routine antenatal testing for GBS carriage and the rate of GBS infection in very young infants is currently more than double that of other high-income countries, many of whom don’t rely on a risk-based approach and have introduced routine antenatal testing instead. This finding was announced amidst new data showing that, between 1996 and 2020, England’s rate of GBS infection in babies has risen by 77%.
But change to improve public health is possible and this was exemplified in Dr Schuchat’s poignant guest essay in The New York Times. After 33 years, she retired as the Principal Deputy Director of the USA’s Center for Disease Control and Prevention (C.D.C) and she reflected on the deeply meaningful work she did on GBS prevention, which has advanced greatly over the past few decades. Research in the 80s identified the benefits of providing at-risk women with antibiotics during labour as a means to prevent GBS infection but it was only when the C.D.C spearheaded a meeting in 1995 where change started to happen. The meeting brought together obstetricians, paediatricians, and parents affected and, a year later, the American College of Obstetricians and Gynaecologists and the American Academy of Paediatrics issued its first guidelines. New standards in practice and updates, like the routine testing of all pregnant people, have prevented what is estimated to be over 100,000 life-threatening infections in newborn babies.
While advocates in high-income countries are working to level-up their prevention strategies so that they’re informed by best practice and on par with other high-income countries, many other countries don’t have strategies. Resource-limited settings would first need to consider testing either universal testing or adopting a risk-based approach but both of these options ultimately rely on the availability of intravenous antibiotics and trained medical staff. When it’s more common to give birth at home, or diagnostic and treatment facilities are limited, or antenatal care and laboratory facilities are lacking, there may be a less dramatic reduction in cases of GBS infection compared to when high-income countries trial the same methods. An