Prevention of neonatal group B streptococcal infections: advances in maternal vaccine development.
OBJECTIVE
We describe the current state of prevention of neonatal group B streptococcal infections and present recent advances toward the development of a maternal vaccine for prevention of this disease.


METHODS
We used a MEDLINE search of the Index Medicus from 1976-1992 for articles regarding group B streptococcus classification and immunology. Group B streptococcus was also cross-referenced with bacterial antigens, antibodies, and vaccines. Relevant textbooks were reviewed.


METHODS
Fifty-seven articles were selected as providing important background and new findings pertinent to this topic.


METHODS
The literature supports prophylactic use of intrapartum antibiotics in mothers who are known carriers of group B streptococcus but highlights the need for more sensitive rapid screening techniques to identify this high-risk population. The promise of intravenous immunoglobulin for neonatal prophylaxis has not been borne out, although hyperimmune and monoclonal preparations offer renewed hope for prophylaxis and adjuvant therapy. Native bacterial polysaccharides, conjugated oligosaccharides and polysaccharides, and C proteins have been investigated as antigens for candidate vaccines. Antibodies elicited in human and animal studies provide protection against bacterial strains possessing these determinants. The theoretical existence of a "universal antigen" is significant because polysaccharide and C protein formulations are required to be polyvalent.


CONCLUSIONS
The development of a vaccine for prevention of neonatal group B streptococcal sepsis is an attainable goal. Further study of the immunogenic properties of bacterial-cell-wall polysaccharides and their conjugates, C proteins, and the potential universal antigen is required.
Coleman
R T
RT
Department of Obstetrics and Gynecology, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, New York.
Sherer
D M
DM
Maniscalco
W M
WM
D001428:Bacterial Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007114:Immunization; D007231:Infant, Newborn; D011135:Polysaccharides, Bacterial / Q000276:immunology; D011247:Pregnancy; D011295:Prenatal Care; D013290:Streptococcal Infections / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000276:immunology
D001428:Bacterial Vaccines; D011135:Polysaccharides, Bacterial