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Abstract

Background

Neonatal early-onset disease caused by group B (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.

Aim

The aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.

Methods

In 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995–2011) and Period II (2012–2019) were collected from each national register, covering 6,605,564 live births.

Results

In Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34–0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80–1.0), specifically 0.89 (95% CI: 0.70–1.5) in Denmark, 0.34 (95% CI: 0.15–0.81) in Iceland, 0.72 (95% CI: 0.59–0.88) in Norway and 0.97 (95% CI: 0.85–1.1) in Sweden.

Conclusions

In this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.

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2024-01-18
2024-12-21
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References

  1. Hood M, Janney A, Dameron G. Beta hemolytic streptococcus group B associated with problems of the perinatal period. Am J Obstet Gynecol. 1961;82(4):809-18.  https://doi.org/10.1016/S0002-9378(16)36146-4  PMID: 13908742 
  2. Seale AC, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ, Hall J, et al. Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis. 2017;65(suppl_2):S200-19.  https://doi.org/10.1093/cid/cix664  PMID: 29117332 
  3. Madrid L, Seale AC, Kohli-Lynch M, Edmond KM, Lawn JE, Heath PT, et al. Infant group B streptococcal disease incidence and serotypes worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017;65(suppl_2):S160-72.  https://doi.org/10.1093/cid/cix656  PMID: 29117326 
  4. Russell NJ, Seale AC, O’Driscoll M, O’Sullivan C, Bianchi-Jassir F, Gonzalez-Guarin J, et al. Maternal colonization with group B Streptococcus and serotype distribution worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017;65(suppl_2):S100-11.  https://doi.org/10.1093/cid/cix658  PMID: 29117327 
  5. Russell NJ, Seale AC, O’Sullivan C, Le Doare K, Heath PT, Lawn JE, et al. Risk of early-onset neonatal group B streptococcal disease with maternal colonization world-wide: Systematic review and meta-analysis. Clin Infect Dis. 2017;65(suppl_2):152-9.  https://doi.org/10.1093/cid/cix655 
  6. Schrag SJ, Verani JR. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine. Vaccine. 2013;31(Suppl 4):D20-6.  https://doi.org/10.1016/j.vaccine.2012.11.056  PMID: 23219695 
  7. Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1-36. PMID: 21088663 
  8. Prevention of group B streptococcal early-onset disease in newborns: ACOG Committee Opinion, Number 797. Obstet Gynecol. 2020;135(2):e51-72.  https://doi.org/10.1097/AOG.0000000000003668  PMID: 31977795 
  9. Seedat F, Geppert J, Stinton C, Patterson J, Freeman K, Johnson SA, et al. Universal antenatal screening for group B streptococcus may cause more harm than good. BMJ. 2019;364:l463.  https://doi.org/10.1136/bmj.l463  PMID: 30787018 
  10. Le Doare K, O’Driscoll M, Turner K, Seedat F, Russell NJ, Seale AC, et al. Intrapartum antibiotic chemoprophylaxis policies for the prevention of group B Streptococcal disease worldwide: systematic review. Clin Infect Dis. 2017;65(suppl_2):S143-51.  https://doi.org/10.1093/cid/cix654  PMID: 29117324 
  11. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017;46(1):348-55. PMID: 27283160 
  12. Ekelund K, Skinhøj P, Madsen J, Konradsen HB. Invasive group A, B, C and G streptococcal infections in Denmark 1999-2002: epidemiological and clinical aspects. Clin Microbiol Infect. 2005;11(7):569-76.  https://doi.org/10.1111/j.1469-0691.2005.01169.x  PMID: 15966976 
  13. Khalil MR, Uldbjerg N, Thorsen PB, Møller JK. Intrapartum PCR assay versus antepartum culture for assessment of vaginal carriage of group B streptococci in a Danish cohort at birth. PLoS One. 2017;12(7):e0180262.  https://doi.org/10.1371/journal.pone.0180262  PMID: 28678829 
  14. Stokholm J, Schjørring S, Pedersen L, Bischoff AL, Følsgaard N, Carson CG, et al. Prevalence and predictors of antibiotic administration during pregnancy and birth. PLoS One. 2013;8(12):e82932.  https://doi.org/10.1371/journal.pone.0082932  PMID: 24340068 
  15. Roed Brogaard L, Dalsgaard Clausen T, Droogh M, Bek Helmig R, Brink Henriksen T, Khalil M, et al. Gruppe B streptokokker - Early onset disease: Profylakse inklusiv GBS screening intrapartum. [Group B streptococci / early onset disease: prophylaxis including intrapartum GBS screening]. Copenhagen: Dansk Selskab for Obstetrik og gynækologi; 2019. Danish. Available from: https://static1.squarespace.com/static/5467abcce4b056d72594db79/t/5ca102ba8165f5e47dc82473/1554055869683/Gruppe%2520B%2520streptokokker%2520-%2520Early%2520onset%2520disease.%2520Profylakse%2520inklusiv%2520GBS%2520screening%2520intrapartum.17.03.19.pdf
  16. Finnish Institute for Health and Welfare (THL). Finnish National Infectious Diseases Register. Helsinki: THL. [Accessed: 29 Mar 2023]. Available from: https://thl.fi/en/web/infectious-diseases-and-vaccinations/surveillance-and-registers/finnish-national-infectious-diseases-register
  17. Lyytikäinen O, Uotila J. Prevention of group b streptococcal infections in newborn infants. Suomen Lääkärilehti.2012;67(50-52):3768-72.
  18. Klemetti R; Hakulinen-Viitanen. Äitiysneuvolaopas - Suosituksia äitiysneuvolatoimintaan. [Maternity advisory board - Recommendations for maternity advisory activities]. Helsinki: Finnish institute for health and welfare; 2013. Finnish. Available from: http://urn.fi/URN:ISBN:978-952-245-972-5
  19. Bjarnadóttir I, Kristinsson KG, Hauksson A, Vilbergsson G, Pálsson G, Dagbjartsson A. [Carriage of group B beta-haemolytic streptococci among pregnant women in Iceland and colonisation of their newborn infants.]. Laeknabladid. 2003;89(2):111-5. Icelandic.  PMID: 16819084 
  20. Landspítali. Fyrirbyggjandi meðferð í fæðingu vegna keðjukokka (streptococcus) af hjúpgerð B (GBS). [Prophylactic treatment in childbirth for streptococcus type B (GBS)]. Reykjavík: Landspítali. [Accessed: 29 Mar 2023]. Icelandic. Available from: https://traveler.lsh.is/focal/gaedahandbaekur/gnhskurda.nsf/0/F15F54157E4BB35B00257E7600370A60
  21. Norwegian Institute of Public Health (NIPH). Norwegian Surveillance System for Communicable Diseases (MSIS). Bergen: NIPH. [Accessed: 29 Mar 2023]. Available from: https://www.fhi.no/en/hn/health-registries/msis
  22. Brigtsen AK, Dedi L, Melby KK, Holberg-Petersen M, Radtke A, Lyng RV, et al. Comparison of PCR and serotyping of Group B Streptococcus in pregnant women: the Oslo GBS-study. J Microbiol Methods. 2015;108:31-5.  https://doi.org/10.1016/j.mimet.2014.11.001  PMID: 25447890 
  23. Norwegian Directorate of Health. Gruppe B-streptokokker hos gravide og fødende (GBS). [Group B streptococci in pregnant and parturient women (GBS)]. Report No.: ISBN 978-82-8081-186-8. Oslo: Helsedirektorate. [Accessed: 29 Mar 2023]. Available from: www.legeforeningen.no/foreningsledd/fagmed/norsk-gynekologisk-forening/veiledere/veileder-i-fodselshjelp/gruppe-b-streptokokker-hos-gravide-og-fodende
  24. Atic Kvalvik S, Brigtsen AK, Findal G, Ween-Velken M, Lone Rolfsen A, Haugli Falch E, et al. Gruppe B streptokokker hos gravide og fødende (GBS). [Group B streptococci in pregnant parturient women (GBS)]. Oslo: Norwegian Medical Association. [Accessed: 29 Mar 2023]. Norwegian. Available from: https://www.legeforeningen.no/ fagmed/norsk-gynekologisk-forening/veiledere/veileder-i-fodselshjelp/gruppe-b-streptokokker-hos-gravide-og-fodende
  25. Svenskt Neonatalt Kvalitetsregister (SNQ). Välkommen till Neonatalvårdsregistret. [Welcome to the neonatal care register]. Stockholm: Karolinska Universitety Hospital. [Accessed: 29 Mar 2023]. Swedish. Available from: www.snq.se
  26. Håkansson S, Källén K. Impact and risk factors for early-onset group B streptococcal morbidity: analysis of a national, population-based cohort in Sweden 1997-2001. BJOG. 2006;113(12):1452-8.  https://doi.org/10.1111/j.1471-0528.2006.01086.x  PMID: 17083655 
  27. Håkansson S, Lilja M, Jacobsson B, Källén K. Reduced incidence of neonatal early-onset group B streptococcal infection after promulgation of guidelines for risk-based intrapartum antibiotic prophylaxis in Sweden: analysis of a national population-based cohort. Acta Obstet Gynecol Scand. 2017;96(12):1475-83.  https://doi.org/10.1111/aogs.13211  PMID: 28832916 
  28. Håkansson S, Axemo P, Bremme K, Bryngelsson A-L, Wallin MC, Ekström C-M, et al. Group B streptococcal carriage in Sweden: a national study on risk factors for mother and infant colonisation. Acta Obstet Gynecol Scand. 2008;87(1):50-8.  https://doi.org/10.1080/00016340701802888  PMID: 18158627 
  29. Prevention av tidiga infektioner med grupp B-streptokocker (GBS) hos nyfödda. Rekommendationer för riskbaserad profylax baserade på underlag från experter. [Prevention of early infections with group B streptococci (GBS) in newborns. Recommendations for risk-based prophylaxis based on expert evidence]. Stockholm: Socialstyrelsen; 2008. Swedish. Available from: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2008-130-7_20081307.pdf
  30. Corvaglia L, Tonti G, Martini S, Aceti A, Mazzola G, Aloisio I, et al. Influence of intrapartum antibiotic prophylaxis for group B Streptococcus on gut microbiota in the first month of life. J Pediatr Gastroenterol Nutr. 2016;62(2):304-8.  https://doi.org/10.1097/MPG.0000000000000928  PMID: 26237371 
  31. Seedat F, Stinton C, Patterson J, Geppert J, Tan B, Robinson ER, et al. Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):247.  https://doi.org/10.1186/s12884-017-1432-3  PMID: 28747160 
  32. Koebnick C, Sidell MA, Getahun D, Tartof SY, Rozema E, Taylor B, et al. Intrapartum antibiotic exposure and body mass index in children. Clin Infect Dis. 2021;73(4):e938-46.  https://doi.org/10.1093/cid/ciab053  PMID: 33493270 
  33. Jauréguy F, Carton M, Panel P, Foucaud P, Butel M-J, Doucet-Populaire F. Effects of intrapartum penicillin prophylaxis on intestinal bacterial colonization in infants. J Clin Microbiol. 2004;42(11):5184-8.  https://doi.org/10.1128/JCM.42.11.5184-5188.2004  PMID: 15528713 
  34. Ekelund K, Skinhøj P, Madsen J, Konradsen HB. Invasive group A, B, C and G streptococcal infections in Denmark 1999-2002: epidemiological and clinical aspects. Clin Microbiol Infect. 2005;11(7):569-76.  https://doi.org/10.1111/j.1469-0691.2005.01169.x  PMID: 15966976 
  35. Horváth-Puhó E, van Kassel MN, Gonçalves BP, de Gier B, Procter SR, Paul P, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. Lancet Child Adolesc Health. 2021;5(6):398-407.  https://doi.org/10.1016/S2352-4642(21)00022-5  PMID: 33894156 
  36. Virranniemi M, Raudaskoski T, Haapsamo M, Kauppila J, Renko M, Peltola J, et al. The effect of screening-to-labor interval on the sensitivity of late-pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study. Acta Obstet Gynecol Scand. 2019;98(4):494-9.  https://doi.org/10.1111/aogs.13522  PMID: 30578547 
Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Verna+Bj%C3%B6rklund&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Björklund Verna</a>, <a href="/search?value1=Harri+Sax%C3%A9n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Saxén Harri</a>, <a href="/search?value1=Olof+Hertting&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hertting Olof</a>, <a href="/search?value1=Emma+Louise+Malchau+Carlsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Malchau Carlsen Emma Louise</a>, <a href="/search?value1=Steen+Hoffmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoffmann Steen</a>, <a href="/search?value1=Stellan+H%C3%A5kansson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Håkansson Stellan</a>, <a href="/search?value1=Valt%C3%BDr+Stef%C3%A1nsson+Thors&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stefánsson Thors Valtýr</a>, <a href="/search?value1=%C3%81sgeir+Haraldsson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haraldsson Ásgeir</a>, <a href="/search?value1=Anne+Karin+Brigtsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brigtsen Anne Karin</a>, <a href="/search?value1=Henrik+D%C3%B6llner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Döllner Henrik</a>, <a href="/search?value1=Heikki+Huhtam%C3%A4ki&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Huhtamäki Heikki</a>, <a href="/search?value1=Tytti+Pokka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pokka Tytti</a>, <a href="/search?value1=Terhi+Susanna+Ruuska&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ruuska Terhi Susanna</a>, <a href="/search?value1=Nordic+Research+Network+for+Paediatric+Infectious+Diseases+Study+Group+%28NORDPID%29&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nordic Research Network for Paediatric Infectious Diseases Study Group (NORDPID)</a></span>. Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019. <a href="/content/ecdc">Euro Surveill.</a> 2024;29(3):pii=2300193. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.3.2300193" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.3.2300193</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 29 Mar 2023;&nbsp;&nbsp; <span class="generated">Accepted</span>: 30 Jun 2023 </span> </p>
/content/10.2807/1560-7917.ES.2024.29.3.2300193
/content/10.2807/1560-7917.ES.2024.29.3.2300193
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