TY - JOUR
T1 - Maternal Colonization with Group B Streptococcus and Serotype Distribution Worldwide
T2 - Systematic Review and Meta-analyses
AU - Russell, Neal J.
AU - Seale, Anna C.
AU - O'Driscoll, Megan
AU - O'Sullivan, Catherine
AU - Bianchi-Jassir, Fiorella
AU - Gonzalez-Guarin, Juan
AU - Lawn, Joy E.
AU - Baker, Carol J.
AU - Bartlett, Linda
AU - Cutland, Clare
AU - Gravett, Michael G.
AU - Heath, Paul T.
AU - Le Doare, Kirsty
AU - Madhi, Shabir A.
AU - Rubens, Craig E.
AU - Schrag, Stephanie
AU - Sobanjo-Ter Meulen, Ajoke
AU - Vekemans, Johan
AU - Saha, Samir K.
AU - Ip, Margaret
N1 - Publisher Copyright:
© 2017 The Author.
PY - 2017
Y1 - 2017
N2 - Background. Maternal rectovaginal colonization with group B Streptococcus (GBS) is the most common pathway for GBS disease in mother, fetus, and newborn. This article, the second in a series estimating the burden of GBS, aims to determine the prevalence and serotype distribution of GBS colonizing pregnant women worldwide. Methods. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus), organized Chinese language searches, and sought unpublished data from investigator groups. We applied broad inclusion criteria to maximize data inputs, particularly from low-and middle-income contexts, and then applied new meta-analyses to adjust for studies with less-sensitive sampling and laboratory techniques. We undertook meta-analyses to derive pooled estimates of maternal GBS colonization prevalence at national and regional levels. Results. The dataset regarding colonization included 390 articles, 85 countries, and a total of 299 924 pregnant women. Our adjusted estimate for maternal GBS colonization worldwide was 18% (95% confidence interval [CI], 17%-19%), with regional variation (11%-35%), and lower prevalence in Southern Asia (12.5% [95% CI, 10%-15%]) and Eastern Asia (11% [95% CI, 10%-12%]). Bacterial serotypes I-V account for 98% of identified colonizing GBS isolates worldwide. Serotype III, associated with invasive disease, accounts for 25% (95% CI, 23%-28%), but is less frequent in some South American and Asian countries. Serotypes VI-IX are more common in Asia. Conclusions. GBS colonizes pregnant women worldwide, but prevalence and serotype distribution vary, even after adjusting for laboratory methods. Lower GBS maternal colonization prevalence, with less serotype III, may help to explain lower GBS disease incidence in regions such as Asia. High prevalence worldwide, and more serotype data, are relevant to prevention efforts.
AB - Background. Maternal rectovaginal colonization with group B Streptococcus (GBS) is the most common pathway for GBS disease in mother, fetus, and newborn. This article, the second in a series estimating the burden of GBS, aims to determine the prevalence and serotype distribution of GBS colonizing pregnant women worldwide. Methods. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus), organized Chinese language searches, and sought unpublished data from investigator groups. We applied broad inclusion criteria to maximize data inputs, particularly from low-and middle-income contexts, and then applied new meta-analyses to adjust for studies with less-sensitive sampling and laboratory techniques. We undertook meta-analyses to derive pooled estimates of maternal GBS colonization prevalence at national and regional levels. Results. The dataset regarding colonization included 390 articles, 85 countries, and a total of 299 924 pregnant women. Our adjusted estimate for maternal GBS colonization worldwide was 18% (95% confidence interval [CI], 17%-19%), with regional variation (11%-35%), and lower prevalence in Southern Asia (12.5% [95% CI, 10%-15%]) and Eastern Asia (11% [95% CI, 10%-12%]). Bacterial serotypes I-V account for 98% of identified colonizing GBS isolates worldwide. Serotype III, associated with invasive disease, accounts for 25% (95% CI, 23%-28%), but is less frequent in some South American and Asian countries. Serotypes VI-IX are more common in Asia. Conclusions. GBS colonizes pregnant women worldwide, but prevalence and serotype distribution vary, even after adjusting for laboratory methods. Lower GBS maternal colonization prevalence, with less serotype III, may help to explain lower GBS disease incidence in regions such as Asia. High prevalence worldwide, and more serotype data, are relevant to prevention efforts.
KW - colonization
KW - group B Streptococcus
KW - pregnancy
KW - serotypes.
KW - vaginal
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U2 - 10.1093/cid/cix658
DO - 10.1093/cid/cix658
M3 - Review article
C2 - 29117327
AN - SCOPUS:85034258662
SN - 1058-4838
VL - 65
SP - S100-S111
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -