Population-based active surveillance for neonatal group B streptococcal infections in Alberta, Canada: Implications for vaccine formulation

H. Dele Davies, Sakina Raj, Carol Adair, Joan Robinson, Alison McGeer

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Background. Knowledge of circulating serotypes of group B Streptococcus (GBS) is important for formulation of vaccines. There are no Canadian data on the serotype distribution of neonatal GBS isolates. Methods. Using a retrospective laboratory and health record survey between 1993 and 1994 (before introduction of Canadian prevention guidelines) and prospective active laboratory-based surveillance from 1995 to 1999 of all laboratories in Alberta, we identified 168 cases of invasive neonatal GBS infections including stillbirths among 262 398 total births; 118 of 123 (96%) isolates from 1995 to 1999 were serotyped, and the corresponding neonatal health records were reviewed. Results. The average annual incidence was 0.64 of 1000 total births/year. Of these 95 (57%) had early onset disease (EOD), 15 (9%) were still births and 58 (34%) had late onset disease (LOD). Eighty-one percent of EOD cases were caused by serotypes Ia, Ia/c, Ia/c/R, III, III/R and V, V/R, whereas 81% of LOD cases were caused by serotypes III and III/R. GBS serotypes containing the C protein along with serotypes III and V as a group constituted 91% (107 of 118) of all GBS cases in our population. The most common clinical presentation was bacteremia without focus (74%) followed by meningitis (14%) and pneumonia (12%). During 1995 to 1999, in addition to 13 stillbirths, there were 6 of 64 (9%) neonatal deaths among EOD cases and 1 of 46 (2%) neonatal death among LOD cases. Conclusions. In this population-based study stillbirths account for a proportion of cases that are not routinely counted and represent a group for which intrapartum antibiotics would likely not be effective, but potentially preventable by vaccination. Inclusion of serotypes Ia, III and V in a conjugate vaccine or serotypes III and V conjugated with the C protein in a GBS vaccine could theoretically provide protection against the majority of GBS invasive disease in Alberta neonates.

Original languageEnglish (US)
Pages (from-to)879-884
Number of pages6
JournalPediatric Infectious Disease Journal
Volume20
Issue number9
DOIs
StatePublished - Oct 1 2001

Fingerprint

Streptococcal Infections
Alberta
Streptococcus agalactiae
Canada
Vaccines
Population
Stillbirth
Parturition
Protein C
Conjugate Vaccines
Serogroup
Bacteremia
Health Surveys
Meningitis
Pneumonia
Vaccination
Guidelines
Anti-Bacterial Agents
Incidence
Infection

Keywords

  • Alberta
  • Canada
  • Group B Streptococcus
  • Immunity
  • Neonate
  • Serotype

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Population-based active surveillance for neonatal group B streptococcal infections in Alberta, Canada : Implications for vaccine formulation. / Davies, H. Dele; Raj, Sakina; Adair, Carol; Robinson, Joan; McGeer, Alison.

In: Pediatric Infectious Disease Journal, Vol. 20, No. 9, 01.10.2001, p. 879-884.

Research output: Contribution to journalArticle

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abstract = "Background. Knowledge of circulating serotypes of group B Streptococcus (GBS) is important for formulation of vaccines. There are no Canadian data on the serotype distribution of neonatal GBS isolates. Methods. Using a retrospective laboratory and health record survey between 1993 and 1994 (before introduction of Canadian prevention guidelines) and prospective active laboratory-based surveillance from 1995 to 1999 of all laboratories in Alberta, we identified 168 cases of invasive neonatal GBS infections including stillbirths among 262 398 total births; 118 of 123 (96{\%}) isolates from 1995 to 1999 were serotyped, and the corresponding neonatal health records were reviewed. Results. The average annual incidence was 0.64 of 1000 total births/year. Of these 95 (57{\%}) had early onset disease (EOD), 15 (9{\%}) were still births and 58 (34{\%}) had late onset disease (LOD). Eighty-one percent of EOD cases were caused by serotypes Ia, Ia/c, Ia/c/R, III, III/R and V, V/R, whereas 81{\%} of LOD cases were caused by serotypes III and III/R. GBS serotypes containing the C protein along with serotypes III and V as a group constituted 91{\%} (107 of 118) of all GBS cases in our population. The most common clinical presentation was bacteremia without focus (74{\%}) followed by meningitis (14{\%}) and pneumonia (12{\%}). During 1995 to 1999, in addition to 13 stillbirths, there were 6 of 64 (9{\%}) neonatal deaths among EOD cases and 1 of 46 (2{\%}) neonatal death among LOD cases. Conclusions. In this population-based study stillbirths account for a proportion of cases that are not routinely counted and represent a group for which intrapartum antibiotics would likely not be effective, but potentially preventable by vaccination. Inclusion of serotypes Ia, III and V in a conjugate vaccine or serotypes III and V conjugated with the C protein in a GBS vaccine could theoretically provide protection against the majority of GBS invasive disease in Alberta neonates.",
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AU - McGeer, Alison

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KW - Neonate

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