Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis.
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.
Jordan
Hannah T
HT
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
Farley
Monica M
MM
Craig
Allen
A
Mohle-Boetani
Janet
J
Harrison
Lee H
LH
Petit
Susan
S
Lynfield
Ruth
R
Thomas
Ann
A
Zansky
Shelley
S
Gershman
Kenneth
K
Albanese
Bernadette A
BA
Schaffner
William
W
Schrag
Stephanie J
SJ
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
D022541:Streptococcal Vaccines