Perinatal Group B Streptococcal Infections: Current Status and Future Directions

Abstract

Group B Streptococcus (GBS) remains the leading cause of neonatal sepsis and meningitis in the United States, despite a dramatic 80% decline in the incidence of early-onset GBS disease with intrapartum antibiotic prophylaxis (IAP). Perinatal GBS disease persists and the incidence of late-onset GBS disease is unchanged. Maternal immunization with conjugate vaccines for the most prevalent serotypes may have a role in further reducing early-onset disease but should have greater impact on late-onset disease. In addition, it could both reduce the problem of antibiotic resistance and potentially prevent adverse neuro-developmental outcomes. Universal vaccination of pregnant women or adolescent women could confer protection beginning in the third trimester, with transplacental transfer of maternal antibodies, extending protection into early infancy. However, this strategy would be of limited benefit to preterm infants, particularly those born before 32 weeks’ gestation. Universal screening of pregnant women at 35 to 37 weeks’ gestation for GBS colonization and providing IAP remain the mainstays for perinatal disease prevention. In this era of widespread IAP, neonatal management is challenging in the asymptomatic at-risk newborn population. Further research is needed to establish sound diagnostic aids, avoid antibiotic misuse, and prevent serious neurologic sequelae.