title: High burden of invasive Streptococcus agalactiae disease in South African infants.
abstract: The epidemiology of invasive Streptococcus agalactiae (GBS) disease was evaluated in South African children. Records of 208/220 children in whom GBS was isolated between January 1997 and December 1999 were reviewed. These included 63%, 31.7% and 5.3% children with early- (EOD, <7 days of age), late- (LOD, age 7-90 days) and childhood-onset disease (COD, age >90 days), respectively. The overall burden of EOD and LOD were 2.06 and 1/1000 live births, respectively. The overall mortality was 19.8% and 13.6% for infants with EOD and LOD, respectively. Risk factors for mortality in infants with EOD and LOD included septic shock (82.1% vs 1.9%), prematurity (35.2% vs 9.6%), low birthweight (29.2% vs 11.0%) and a leucocyte count <5000/mm(3) (43.5% vs 18.6%). Eight (72.7%) of 11 children with COD had an immunosuppressive, predisposing cause for invasive bacterial disease. In infants with EOD and LOD, serotype III isolates caused 49.2% and 75.7% of disease, respectively, and, together with serotype Ia isolates, caused 78.9% and 100% of invasive disease, respectively. Invasive GBS disease is common in South African infants and current strategies aimed at reducing the burden of the disease should be reconsidered.
authors.affiliation: NHLS/Wits/MRC Pneumococcal Diseases Research Unit, University of the Witswaterand, Johannesburg, South Africa. shabirm@mail.saimr.wits.ac.za
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
authors.forename: Kholeka
authors.initials: K
authors.lastname: Radebe
authors.forename: Heather
authors.initials: H
authors.lastname: Crewe-Brown
authors.forename: Carl E
authors.initials: CE
authors.lastname: Frasch
authors.forename: Guthrie
authors.initials: G
authors.lastname: Arakere
authors.forename: Mantoa
authors.initials: M
authors.lastname: Mokhachane
authors.forename: Alan
authors.initials: A
authors.lastname: Kimura
mesh_terms: D017668:Age of Onset; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007958:Leukocyte Count; D008297:Male; D008581:Meningitis / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications; D012307:Risk Factors; D012772:Shock, Septic / Q000150:complications; D013019:South Africa / Q000453:epidemiology; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D013292:Streptococcus agalactiae