title: A Multi-Country Cross-Sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and Escherichia coli in Resource-Poor Settings: Prevalences and Risk Factors.
abstract: BACKGROUND
  One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries.
  
  
  METHODS
  A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis.
  
  
  RESULTS
  Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2% (95% CI, 13.7-28.7%) and 23.1% (95% CI, 16.2-31.9%), respectively for GBS; and 25.0% (95% CI, 17.8-33.9%) and 27.1% (95% CI, 19.6-36.2%), respectively for E. coli. GBS serotypes Ia (36.8%), V (26.3%) and III (14.0%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated.
  
  
  CONCLUSIONS
  Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population.
authors.affiliation: Laboratory Bacteriology Research, Department of Microbiology, Immunology, and Clinical Chemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Cools
authors.affiliation: Unit of Epidemiology and Control of HIV/STD, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vicky
authors.initials: V
authors.lastname: Jespers
authors.affiliation: Unit of Epidemiology and Control of HIV/STD, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Hardy
authors.affiliation: HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Tania
authors.initials: T
authors.lastname: Crucitti
authors.affiliation: Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: ICRH Kenya, Mombasa, Kenya.
authors.forename: Mary
authors.initials: M
authors.lastname: Mwaura
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Gilles F
authors.initials: GF
authors.lastname: Ndayisaba
authors.affiliation: Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Janneke H H M
authors.initials: JH
authors.lastname: van de Wijgert
authors.affiliation: Laboratory Bacteriology Research, Department of Microbiology, Immunology, and Clinical Chemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: Mario
authors.initials: M
authors.lastname: Vaneechoutte
mesh_terms: D000293:Adolescent; D000328:Adult; D002176:Candida albicans / Q000235:genetics / Q000302:isolation & purification; D002353:Carrier State / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003710:Demography; D004926:Escherichia coli / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D065288:Serogroup; D013019:South Africa / Q000453:epidemiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013292:Streptococcus agalactiae / Q000235:genetics / Q000302:isolation & purification; D014621:Vagina / Q000382:microbiology*; D055815:Young Adult
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