Early-onset group B streptococcal disease in the United States: potential for further reduction.
OBJECTIVE
To describe lapses in adherence to group B streptococcus (GBS) prevention guidelines among cases of early-onset GBS disease in term and preterm neonates and to estimate the potential for further reduction in disease burden under current prevention strategies.


METHODS
We reviewed labor and delivery and prenatal records of mothers of neonates with early-onset GBS disease (aged younger than 7 days with GBS isolated from a normally sterile site) identified at population-based surveillance sites in 2008-2009. We interviewed prenatal care providers about GBS screening practices and obtained relevant laboratory records. We evaluated the data for errors in prenatal screening, laboratory methods, communication of results, and intrapartum antibiotic prophylaxis. Using published data on screening sensitivity and intrapartum prophylaxis effectiveness, we estimated the potential reduction in cases under optimal prevention implementation.


RESULTS
Among 309 cases, 179 (57.9%) had one or more implementation errors. The most common error type in term and preterm case-patients was prenatal screening (80 of 222 [36.0%]) and intrapartum prophylaxis (46 of 85 [54.1%]), respectively. We estimated that under optimal implementation, cases of early-onset GBS disease could be reduced by 26-59% with the largest benefit from a single intervention coming from improved use of intrapartum prophylaxis (16% decrease).


CONCLUSIONS
Further reduction of early-onset GBS disease burden is possible under current prevention strategies, particularly with improved implementation of antibiotic prophylaxis. However, even with perfect adherence to recommended practices, the decline in cases may be modest. Therefore, novel prevention approaches such as improved intrapartum assays and vaccines are also needed.
Centers for Disease Control and Prevention, the Georgia Emerging Infections Program/Atlanta VA Medical Center, and the Georgia Department of Community Health, Atlanta, Georgia; the Emerging Infections Program, New York State Department of Health, Albany, New York; the Minnesota Department of Health, St. Paul, Minnesota; Vanderbilt University School of Medicine, Nashville, Tennessee; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the University of New Mexico, Albuquerque, New Mexico; the Colorado Department of Public Health and Environment, Denver, Colorado; the Connecticut Department of Public Health, Hartford, Connecticut; the Oregon Public Health Division, Portland, Oregon; and the California Emerging Infections Program, Oakland, California.
Jennifer R
JR
Verani
Nancy L
NL
Spina
Ruth
R
Lynfield
William
W
Schaffner
Lee H
LH
Harrison
Amy
A
Holst
Stepy
S
Thomas
Jessica M
JM
Garcia
Karen
K
Scherzinger
Deborah
D
Aragon
Susan
S
Petit
Jamie
J
Thompson
Lauren
L
Pasutti
Roberta
R
Carey
Lesley
L
McGee
Emily
E
Weston
Stephanie J
SJ
Schrag
D017668:Age of Onset; D019072:Antibiotic Prophylaxis / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013292:Streptococcus agalactiae; D047929:Term Birth; D014481:United States / Q000453:epidemiology