Group B Streptococcal Disease in the Era of Intrapartum Antibiotic Prophylaxis
Stephanie J. Schrag, D.Phil., Sara Zywicki, M.P.H., Monica M. Farley, M.D., Arthur L. Reingold, M.D., Lee H. Harrison, M.D., Lewis B. Lefkowitz, M.D., James L. Hadler, M.D., Richard Danila, M.D., Paul R. Cieslak, M.D., and Anne Schuchat, M.D.
Background Group B streptococcal infections are a leading causeof neonatal mortality, and they also affect pregnant women andthe elderly. Many cases of the disease in newborns can be preventedby the administration of prophylactic intrapartum antibiotics.In the 1990s, prevention efforts increased. In 1996, consensusguidelines recommended use of either a risk-based or a screening-basedapproach to identify candidates for intrapartum antibiotics.To assess the effects of the preventive efforts, we analyzedtrends in the incidence of group B streptococcal disease from1993 to 1998.
Methods Active, population-based surveillance was conductedin selected counties of eight states. A case was defined bythe isolation of group B streptococci from a normally sterilesite. Census and live-birth data were used to calculate therace-specific incidence of disease; national projections wereadjusted for race.
Results Disease in infants less than seven days old accountedfor 20 percent of all 7867 group B streptococcal infections.The incidence of early-onset neonatal infections decreased by65 percent, from 1.7 per 1000 live births in 1993 to 0.6 per1000 in 1998. The excess incidence of early-onset disease inblack infants, as compared with white infants, decreased by75 percent. Projecting our findings to the entire United States,we estimate that 3900 early-onset infections and 200 neonataldeaths were prevented in 1998 by the use of intrapartum antibiotics.Among pregnant girls and women, the incidence of invasive groupB streptococcal disease declined by 21 percent. The incidenceamong nonpregnant adults did not decline.
Conclusions Over a six-year period, there has been a substantialdecline in the incidence of group B streptococcal disease innewborns, including a major reduction in the excess incidenceof these infections in black infants. These improvements coincidewith the efforts to prevent perinatal disease by the wider useof prophylactic intrapartum antibiotics.
Source Information
From the Centers for Disease Control and Prevention, Atlanta (S.J.S., S.Z., A.S.); the Emory University School of Medicine and Veterans Affairs Medical Services, Atlanta (M.M.F.); the School of Public Health, University of California, Berkeley (A.L.R.); the Johns Hopkins School of Hygiene and Public Health, Baltimore (L.H.H.); Vanderbilt Medical Center, Nashville (L.B.L.); the Connecticut Department of Public Health, Hartford (J.L.H.); the Minnesota Department of Health, Minneapolis (R.D.); and the Department of Human Resources, Portland, Oreg. (P.R.C.). The members of the surveillance team are listed in the Appendix.
Address reprint requests to Dr. Schrag at the Respiratory Diseases Branch, MS-C23, Division of Bacterial and Mycotic Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, or at zha6{at}cdc.gov.
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