title: Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya.
abstract: Streptococcus agalactiae (group B streptococcus, GBS) causes neonatal disease and stillbirth, but its burden in sub-Saharan Africa is uncertain. We assessed maternal recto-vaginal GBS colonization (7,967 women), stillbirth and neonatal disease. Whole-genome sequencing was used to determine serotypes, sequence types and phylogeny. We found low maternal GBS colonization prevalence (934/7,967, 12%), but comparatively high incidence of GBS-associated stillbirth and early onset neonatal disease (EOD) in hospital (0.91 (0.25-2.3)/1,000 births and 0.76 (0.25-1.77)/1,000 live births, respectively). However, using a population denominator, EOD incidence was considerably reduced (0.13 (0.07-0.21)/1,000 live births). Treated cases of EOD had very high case fatality (17/36, 47%), especially within 24 h of birth, making under-ascertainment of community-born cases highly likely, both here and in similar facility-based studies. Maternal GBS colonization was less common in women with low socio-economic status, HIV infection and undernutrition, but when GBS-colonized, they were more probably colonized by the most virulent clone, CC17. CC17 accounted for 267/915 (29%) of maternal colonizing (265/267 (99%) serotype III; 2/267 (0.7%) serotype IV) and 51/73 (70%) of neonatal disease cases (all serotype III). Trivalent (Ia/II/III) and pentavalent (Ia/Ib/II/III/V) vaccines would cover 71/73 (97%) and 72/73 (99%) of disease-causing serotypes, respectively. Serotype IV should be considered for inclusion, with evidence of capsular switching in CC17 strains.
authors: Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK.|KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Anna C
authors: 0000-0002-0129-3146
authors: AC
authors: Seale
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Angela C
authors: AC
authors: Koech
authors: Modernizing Medical Microbiology Consortium, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
authors: Anna E
authors: AE
authors: Sheppard
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Hellen C
authors: HC
authors: Barsosio
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Joyce
authors: J
authors: Langat
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Emily
authors: E
authors: Anyango
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Stella
authors: S
authors: Mwakio
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Salim
authors: S
authors: Mwarumba
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.|London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors: Susan C
authors: SC
authors: Morpeth
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Kirimi
authors: K
authors: Anampiu
authors: Modernizing Medical Microbiology Consortium, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
authors: Alison
authors: A
authors: Vaughan
authors: Modernizing Medical Microbiology Consortium, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
authors: Adam
authors: A
authors: Giess
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Polycarp
authors: P
authors: Mogeni
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Leahbell
authors: L
authors: Walusuna
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Hope
authors: H
authors: Mwangudzah
authors: Maternity Department, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: Doris
authors: D
authors: Mwanzui
authors: Maternity Department, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: Mariam
authors: M
authors: Salim
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.|Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, OX3 9DU, UK.
authors: Bryn
authors: B
authors: Kemp
authors: Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK.|KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.|London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors: Caroline
authors: C
authors: Jones
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Neema
authors: N
authors: Mturi
authors: KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Benjamin
authors: B
authors: Tsofa
authors: County Ministry of Health, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: Edward
authors: E
authors: Mumbo
authors: County Ministry of Health, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: David
authors: D
authors: Mulewa
authors: Department of Paediatrics, Coast Provincial General Hospital, Mombasa 80100, Kenya.
authors: Victor
authors: V
authors: Bandika
authors: Department of Obstetrics and Gynaecology, Coast Provincial General Hospital, Mombasa 80100, Kenya.
authors: Musimbi
authors: M
authors: Soita
authors: Maternity Department, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: Maureen
authors: M
authors: Owiti
authors: Maternity Department, Kilifi County Hospital, Main Hospital Road, Kilifi 80108, Kenya.
authors: Norris
authors: N
authors: Onzere
authors: Modernizing Medical Microbiology Consortium, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
authors: A Sarah
authors: AS
authors: Walker
authors: Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia, 30333, USA.
authors: Stephanie J
authors: SJ
authors: Schrag
authors: Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, OX3 9DU, UK.
authors: Stephen H
authors: SH
authors: Kennedy
authors: Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK.|KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: Greg
authors: 0000-0002-2663-2765
authors: G
authors: Fegan
authors: Modernizing Medical Microbiology Consortium, Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK.
authors: Derrick W
authors: DW
authors: Crook
authors: Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK.|KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya.
authors: James A
authors: JA
authors: Berkley
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016680:Genome, Bacterial; D015658:HIV Infections / Q000453:epidemiology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D010802:Phylogeny; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D012007:Rectum / Q000382:microbiology; D065288:Serogroup; D012959:Socioeconomic Factors; D050497:Stillbirth / Q000453:epidemiology*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D022541:Streptococcal Vaccines / Q000008:administration & dosage; D013292:Streptococcus agalactiae / Q000235:genetics / Q000254:growth & development* / Q000302:isolation & purification / Q000472:pathogenicity; D014621:Vagina / Q000382:microbiology; D055815:Young Adult
chemical_list: D022541:Streptococcal Vaccines