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Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Bronner P. Gonçalves, London School of Hygiene and Tropical Medicine
  • ,
  • Simon R. Procter, London School of Hygiene and Tropical Medicine
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  • Proma Paul, London School of Hygiene and Tropical Medicine
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  • Jaya Chandna, London School of Hygiene and Tropical Medicine
  • ,
  • Alexandra Lewin, London School of Hygiene and Tropical Medicine
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  • Farah Seedat, London School of Hygiene and Tropical Medicine
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  • Artemis Koukounari, London School of Hygiene and Tropical Medicine
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  • Ziyaad Dangor, University of the Witwatersrand
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  • Shannon Leahy, University of the Witwatersrand
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  • Sridhar Santhanam, Christian Medical College
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  • Hima B. John, Christian Medical College
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  • Justina Bramugy, Centro de Investigação em Saúde de Manhiça
  • ,
  • Azucena Bardají, Centro de Investigação em Saúde de Manhiça, University of Barcelona
  • ,
  • Amina Abubakar, Wellcome Trust Research Laboratories Nairobi, Aga Khan University
  • ,
  • Carophine Nasambu, Wellcome Trust Research Laboratories Nairobi
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  • Romina Libster, Fundación INFANT
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  • Clara Sánchez Yanotti, Fundación INFANT
  • ,
  • Erzsébet Horváth-Puhó
  • Henrik T. Sørensen
  • Diederik van de Beek, University of Amsterdam
  • ,
  • Merijn W. Bijlsma, University of Amsterdam
  • ,
  • William M. Gardner, University of Washington
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  • Nicholas Kassebaum, University of Washington
  • ,
  • Caroline Trotter, Department of Veterinary Medicine
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  • Quique Bassat, Centro de Investigação em Saúde de Manhiça, University of Barcelona, ICREA, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública
  • ,
  • Shabir A. Madhi, University of the Witwatersrand
  • ,
  • Philipp Lambach, World Health Organization
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  • Mark Jit, London School of Hygiene and Tropical Medicine
  • ,
  • Joy E. Lawn, London School of Hygiene and Tropical Medicine
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  • GBS Danish and Dutch collaborative group for long term outcomes
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  • GBS Low and Middle Income Countries collaborative group for long term outcomes
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  • GBS Scientific Advisory Group, epidemiological sub-group
  • ,
  • CHAMPS team

Background: Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets. Methods: We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and estimated the burden for 183 countries in 2020 regarding: maternal GBS colonisation, iGBS cases and deaths in infants younger than 3 months, children surviving iGBS affected by NDI, and maternal iGBS cases. We analysed the proportion of stillbirths with GBS and applied this to the UN-estimated stillbirth risk per country. Excess preterm births associated with maternal GBS colonisation were calculated using meta-analysis and national preterm birth rates. Findings: Data from the seven systematic reviews, published in 2017, that informed the previous burden estimation (a total of 515 data points) were combined with new data (17 data points) from large multicountry studies on neurodevelopmental impairment (two studies) and stillbirths (one study). A posterior median of 19·7 million (95% posterior interval 17·9–21·9) pregnant women were estimated to have rectovaginal colonisation with GBS in 2020. 231 800 (114 100–455 000) early-onset and 162 200 (70 200–394 400) late-onset infant iGBS cases were estimated to have occurred. In an analysis assuming a higher case fatality rate in the absence of a skilled birth attendant, 91 900 (44 800–187 800) iGBS infant deaths were estimated; in an analysis without this assumption, 58 300 (26 500–125 800) infant deaths from iGBS were estimated. 37 100 children who recovered from iGBS (14 600–96 200) were predicted to develop moderate or severe NDI. 40 500 (21 500–66 200) maternal iGBS cases and 46 200 (20 300–111 300) GBS stillbirths were predicted in 2020. GBS colonisation was also estimated to be potentially associated with considerable numbers of preterm births. Interpretation: Our analysis provides a comprehensive assessment of the pregnancy-related GBS burden. The Bayesian approach enabled coherent propagation of uncertainty, which is considerable, notably regarding GBS-associated preterm births. Our findings on both the acute and long-term consequences of iGBS have public health implications for understanding the value of investment in maternal GBS immunisation and other preventive strategies. Funding: Bill & Melinda Gates Foundation.

OriginalsprogEngelsk
TidsskriftThe Lancet Global Health
Vol/bind10
Nummer6
Sider (fra-til)e807-e819
Antal sider13
ISSN2214-109X
DOI
StatusUdgivet - jun. 2022

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