title: Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis.
abstract: BACKGROUND
  Intrapartum antibiotic prophylaxis for neonatal group B streptococcal disease (GBS) effectively prevents disease among infants <7 days old, but there are no prevention strategies for late-onset GBS disease (onset on days 7-89 of life). We describe trends in late-onset GBS over a 16-year period to characterize disease burden and estimate vaccine preventability.
  
  
  METHODS
  We conducted active, population-based surveillance for invasive late-onset GBS disease in 10 states from 1990 to 2005. A case was defined by GBS isolation from a normally sterile site on day 7-89 of life in a surveillance area resident. Incidence rates were calculated per 1000 resident live births.
  
  
  RESULTS
  We identified 1726 cases; 26% presented with meningitis, and the case fatality ratio was 4.3%. Incidence was similar throughout the study period. Incidence among black infants was approximately 3 times that among non-black infants; the disparity persisted when data were stratified by gestational age. We estimate approximately 1300 cases of late-onset GBS occur annually in the United States. Birth at <37 weeks gestation was common among case-infants (49%) and was associated with elevated case fatality (relative risk: 3.8; 95% confidence interval: 1.1-13.2). Of 653 serotyped isolates, serotypes III (53%), IA (24%), and V (13%) predominated. During 2003-2005, 81 (36%) of the 227 cases caused by serotypes III, IA, and V were born before 34 weeks gestation.
  
  
  CONCLUSIONS
  The late-onset GBS disease burden remains substantial. A trivalent vaccine could be an effective prevention strategy. Because many cases were born preterm, reducing the opportunity for transplacental antibody transfer, adolescent immunization should be considered.
authors.affiliation: Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30309, USA. hjordan1@health.nyc.gov
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: Allen
authors.initials: A
authors.lastname: Craig
authors.forename: Janet
authors.initials: J
authors.lastname: Mohle-Boetani
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Susan
authors.initials: S
authors.lastname: Petit
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.forename: Shelley
authors.initials: S
authors.lastname: Zansky
authors.forename: Kenneth
authors.initials: K
authors.lastname: Gershman
authors.forename: Bernadette A
authors.initials: BA
authors.lastname: Albanese
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
mesh_terms: D016001:Confidence Intervals; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D015997:Neonatal Screening; D011159:Population Surveillance; D011247:Pregnancy; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D022541:Streptococcal Vaccines / Q000008:administration & dosage* / Q000627:therapeutic use; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022541:Streptococcal Vaccines