Author(s): Jordan HT, Farley MM, Craig A, MohleBoetani J, Harrison LH,
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Abstract 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.
This article was published in Pediatr Infect Dis J
and referenced in Clinical Depression