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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.

SUBMITTER: Seale AC 

PROVIDER: S-EPMC4936517 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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

Seale Anna C AC   Koech Angela C AC   Sheppard Anna E AE   Barsosio Hellen C HC   Langat Joyce J   Anyango Emily E   Mwakio Stella S   Mwarumba Salim S   Morpeth Susan C SC   Anampiu Kirimi K   Vaughan Alison A   Giess Adam A   Mogeni Polycarp P   Walusuna Leahbell L   Mwangudzah Hope H   Mwanzui Doris D   Salim Mariam M   Kemp Bryn B   Jones Caroline C   Mturi Neema N   Tsofa Benjamin B   Mumbo Edward E   Mulewa David D   Bandika Victor V   Soita Musimbi M   Owiti Maureen M   Onzere Norris N   Walker A Sarah AS   Schrag Stephanie J SJ   Kennedy Stephen H SH   Fegan Greg G   Crook Derrick W DW   Berkley James A JA  

Nature microbiology 20160523 7


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)  ...[more]

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