Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya.


Seale, AC; Koech, AC; Sheppard, AE; Barsosio, HC; Langat, J; Anyango, E; Mwakio, S; Mwarumba, S; Morpeth, SC; Anampiu, K; Vaughan, A; Giess, A; Mogeni, P; Walusuna, L; Mwangudzah, H; Mwanzui, D; Salim, M; Kemp, B; Jones, C; Mturi, N; Tsofa, B; Mumbo, E; Mulewa, D; Bandika, V; Soita, M; Owiti, M; Onzere, N; Walker, AS; Schrag, SJ; Kennedy, SH; Fegan, G; Crook, DW; Berkley, JA; (2016) Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya. Nat Microbiol, 1 (7). p. 16067. ISSN 2058-5276 DOI: https://doi.org/10.1038/nmicrobiol.2016.67

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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.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 27572968
Web of Science ID: 383605700010
URI: http://researchonline.lshtm.ac.uk/id/eprint/2866231

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