title: Disease Burden of Group B Streptococcus Among Infants in Sub-Saharan Africa: A Systematic Literature Review and Meta-analysis.
abstract: Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence and GBS serotype distribution.
  
  
  
  MEDLINE, MEDLINE in process and Cochrane Library were searched for studies published during 1990-2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS disease incidence, late-onset GBS disease incidence and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals (CIs).
  
  
  
  We identified 17 studies of colonization, 9 of disease incidence, and 6 of serotype distribution meeting inclusion criteria. 21.8% (95% CI: 18.3, 25.5) of expectant women were colonized with GBS. The incidence of early-onset GBS disease was 1.3 per 1000 births (95% CI: 0.81, 1.9), that of late-onset GBS disease 0.73 per 1000 births (95% CI: 0.48, 1.0). The most common disease-causing serotype was 3, followed by 1a. Serotypes 1b, 2 and 5 were next most common in frequency.
  
  
  
  Despite methodological factors leading to underestimation, GBS disease incidence appears high in sub-Saharan Africa. A small number of GBS serotypes cause almost all disease. GBS disease burden in sub-Saharan Africa suggests that safe, effective and affordable GBS disease prevention is needed.
authors.affiliation: From the *Department of Health Systems and Policy, Rutgers School of Public Health, Newark, New Jersey; †Institute for Health, Health Care Policy, and Aging Research, Rutgers - The State University of New Jersey, New Brunswick, New Jersey; ‡Division of Bacterial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; §KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya & Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom; ¶College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; ‖Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; and **Division of Management, Policy and Community Health University of Texas School of Public Health, San Antonio, Texas.
authors.forename: Anushua
authors.initials: A
authors.lastname: Sinha
authors.forename: Louise B
authors.initials: LB
authors.lastname: Russell
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Verani
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Schrag
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.forename: Musa
authors.initials: M
authors.lastname: Mohammed
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigauque
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Kim
mesh_terms: D017954:Africa South of the Sahara; D002353:Carrier State; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D008581:Meningitis; D000071074:Neonatal Sepsis; D011247:Pregnancy; D013290:Streptococcal Infections; D022541:Streptococcal Vaccines; D013292:Streptococcus agalactiae
chemical_list: D022541:Streptococcal Vaccines