Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)
Author:
Mahtab Sana1, Madewell Zachary J2, Madhi Shabir A1, Wise Amy3, Swart Peter J4, Velaphi Sithembiso5, Mandomando Inacio67, Bramugy Justina6, Mabunda Rita8, Xerinda Elisio6, Scott Anthony G9, Assefa Nega10, Madrid Lola910, Bweihun Mulu11, Temesgen Fikremelekot11, Onyango Dickens12, Akelo Victor13, Oliech Richard14, Otieno Peter14, Verani Jennifer R15, Arifeen Shams El16, Gurley Emily S1617, Alam Muntasir16, Rahman Afruna16, Hossain Mohammad Zahid16, Sow Samba18, Kotloff Karen19, Tapia Milagritos19, Keita Adama Mamby18, Sanogo Doh18, Ogbuanu Ikechukwu20, Ojulong Julius21, Lako Sandra22, Ita Okokon20, Kaluma Erick20, Wilson Tais2, Mutevedzi Portia23, Barr Beth A Tippett14, Whitney Cynthia G23, Blau Dianna M2, Bassat Quique68242526, Adam Yasmin, Agaya Janet, Ajanovic Sara, Alemu Addisu, Ali Solomon, Aol George, Badji Henry, Bari Sanwarul, Bramugy Justina, Bunn James, Chawana Richard, Chowdhury Atique Iqbal, Fairchild Karen D, Fentaw Surafel, Flora Meerjady Sabrina, Gethi Dickson, Govender Nelesh P, Greene Carol L, Gure Tadesse, Hale Martin, Hurtado Juan Carlos, Igunza Kitiezo Aggrey, Islam Farzana, Johnson J Kristie, Keita Tatiana, Khagayi Sammy, Khan Iqbal Ansary, Koka Rima, Kone Diakaridia, Kourouma Nana, Kuria Magdalene N, Lako Sandra, Lala Sanjay G, Lombaard Hennie, Luke Ronita, Misore Thomas, Mitei Paul K, Ibrahim Alexander M, Moultrie Andrew, Murila Florence V, Myburgh Nellie, Nyamthimba Peter, Oliech Richard, Omore Richard, Onwuchekwa Uma U, Orlien Stian M S, Othieno Louis, Otieno Peter, Otieno Kephas, Ouma Gregory, Owuor Benard, Parveen Shahana, Petersen Karen L, Rahman Mahbubur, Rakislova Natalia, Rogena Emily A, Sanogo Doh, Shirin Tahmina, Sidibe Diakaridia, Sissoko Seydou, Solomon Fatima, Sorour Gillian, Squire James Sylvester, Swart Peter J, Temesgen Fikremelekot, Tennant Sharon M, Thwala Bukiwe Nana, Traore Cheick Bougadari, Velaphi Sithembiso, Vitorino Pio, Wadula Jeannette, Yeshi Melisachew Mulatu,
Affiliation:
1. South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa 2. Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia , USA 3. National Health for Laboratory Service in South Africa, Johannesburg , South Africa 4. Department of Obstetrics and Gynecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand , Johannesburg , South Africa 5. Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa 6. Centro de Investigação em Saúde de Manhiça (CISM) , Maputo , Mozambique 7. Instituto Nacional de Saúde (INS) , Maputo , Mozambique 8. ISGlobal—Hospital Clínic, Unversitat de Barcelona , Barcelona , Spain 9. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine , London , United Kingdom 10. College of Health and Medical Sciences, Haramaya University , Harar , Ethiopia 11. Addis Ababa University , Addis Ababa , Ethiopia 12. Kisumu County Department of Health, Ministry of Health , Kisumu , Kenya 13. US Centers for Disease Control and Prevention–Kenya , Kisumu , Kenya 14. Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR) , Kisumu , Kenya 15. National Center for Immunization and Respiratory Disease, Centers for Disease Control , Atlanta, Georgia , USA 16. International Center for Diarrhoeal Diseases Research (icddr, b) , Dhaka , Bangladesh 17. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA 18. Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé , Bamako , Mali 19. Center for Vaccine Development and Global Health, University of Maryland School of Medicine , Baltimore, Maryland , USA 20. Crown Agents , Freetown , Sierra Leone 21. ICAP—Columbia University , Makeni , Sierra Leone 22. Aberdeen Women's Centre in Freetown, Sierra Leone 23. Emory Global Health Institute, Emory University , Atlanta, Georgia , USA 24. Institutó Catalana de Recerca I Estudis Avançats (ICREA) , Barcelona , Spain 25. Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona , Barcelona , Spain 26. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) , Madrid , Spain
Abstract
Abstract
Background
Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS).
Methods
Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death.
Results
We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48).
Conclusions
Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
Funder
Bill & Melinda Gates Foundation
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
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