preventing life-threatening GBS infections in newborn babies
www.gbss.org.uk
Who is Group B Strep
Support?
What is Group B
Streptococcus?
What is the impact of
Group B Strep
infection?
What is the current
testing approach to
Group B Strep in the
UK?
What is the current
approach towards
giving pregnant women
information about
Group B Strep in the
UK?
What is the current
treatment approach to
Group B Strep?
Group B Strep Support (GBSS) is an independent national charity which provides
accurate information on group B Strep (GBS) to families and health
professionals and aims to generate continued support for research into
preventing group B Strep infections in newborn babies.
Group B Streptococcus (GBS) is the UK’s most common cause of life-threatening
infection in newborn babies1. It is a normally harmless bacteria carried by
around 25% of pregnant women2 and most babies are not affected by it.
However, when it does cause infections, these can be devastating.
In 2003, it was estimated that at least 340 babies a year in the UK develop GBS
infection within seven days of birth. One in ten of these infected babies will die3
of blood poisoning, pneumonia or meningitis, while around one in five will be
permanently affected by cerebral palsy, blindness, deafness or serious learning
difficulties4. GBS infection is increasing in the UK.
Between 2003-2010, the number of reported cases of GBS infection in newborn
babies in England, Wales & Northern Ireland alone rose by 44%5 to 3026.
There is no national testing programme for GBS in the UK. Most people don’t
know if they carry GBS as there are no symptoms. At present a test will only be
done as a consequence of other concerns in pregnancy. However, the routine
tests that are then offered are not specifically designed to detect GBS and only
pick up GBS carriage in the mother about 50% of the time7. In other words,
there is a high level of falsely negative results.
Pregnant women need to know about GBS to ask about it, as little information is
routinely provided to women as part of their antenatal care. Policies at
maternity hospitals on preventing GBS infection vary considerably and there are
no guidelines for midwives to discuss it with pregnant mothers. One survey
found that 42% of the women who were aware of group B Strep heard about it
from a pregnancy book or magazine. For only 1 in 5 of aware mothers was their
source of information their midwife or doctor.8
In the UK, clinicians use a ‘risk factor’ approach, rather than an approach
involving testing, in order to decide which mothers should be offered treatment
in the form of intravenous antibiotics during labour.
The November 2003 guidelines from the Royal College of Obstetricians and
Gynaecologists (RCOG) list a series of risk factors that should be considered
1
RCOG. Prevention of early onset neonatal group B Streptococcal disease. Green top guideline 36, 2003.
American College of Obstetricians and Gynecologists. ACOG Committee Opinion: No 279: Prevention of Early onset Group B Streptococcal Disease in
Newborns. Obstet Gynecol 2002; 100 (6): 1405-1412.
3 BMJ Group patient leaflet, Infection in newborn babies (group B streptococcus), March 23 2009. BMJ Publishing Group Ltd 2009.
4 J Med Screen. Maternal screening to prevent neonatal Group B streptococcal disease. Journal of Medical Screening 2002; 9 (4)
5 Pyogenic and non-pyogenic streptococcal bacteraemia, England, Wales and Northern Ireland: 2003.
Commun Dis Rep Wkly [serial online] 2004; 13(16): Bacteraemia
6 Pyogenic and non-pyogenic streptococcal bacteraemia, England, Wales and Northern Ireland: 2010 (PDF, 697 KB) Health Protection Report [serial
online] 2011; 5(46): Bacteraemia
7 Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review.
Pediatrics 1999; 103(6):e77.
8 Bounty Parenting Club Word of Mum Panel survey, May 2010
2
Group B Strep Support, PO Box 203, Haywards Heath, West Sussex RH16 1GF
E-mail: jplumb@gbss.org.uk
Tel: 01444 416176
Fax: 0870 803 0024
Registered Charity No: 1112065 Registered Co No: 5587535
20 January 2012
What screening and
treatment alternatives
are there?
including: going into labour before 37 weeks, having a high fever in labour,
previously having a baby with GBS infection or finding that the mother is a GBS
carrier. In other words, GBS carriage is recognised by RCOG as an important
enough risk factor for infection in the baby to warrant preventative treatment
but not important enough to recommend screening for it.
Enriched Culture Medium (ECM) tests, known as sensitive tests, are available
privately (for approximately £35) and from a handful of NHS hospitals in the UK.
These tests follow the Health Protection Agency’s recommended procedure9
and are recognised as the ‘gold standard’ for identifying GBS carriage but they
are not commonly used by the NHS. While GBS carriage can come and go, a
woman’s GBS status as determined by an ECM test, is not likely to change for
about 5 weeks10. So, testing at 35-37 weeks of pregnancy is very good at
predicting the chance of carrying GBS at delivery.
In the US, Canada, Australia and many European countries, programmes of
testing late in pregnancy and offering intravenous antibiotics in labour to those
women whose babies are at higher risk of GBS infection have been widely
adopted and found to be effective. In the US, the incidence per 1000 live births
has fallen from more than 1.5 during the early 1990s, to 0.28 in 2008 (a fall of
80%11).
What are the costs?
Up to 90% of early onset GBS infection could be prevented if intravenous
antibiotics were offered in labour to all GBS carriers and pregnant women
whose newborn babies are at higher risk of developing GBS infection12.
Cost benefit studies of UK practice published in 200713 and 201014 15 have shown
that sensitive testing is more cost effective than using risk factors alone in
selecting which women should be offered antibiotics in labour.
Research has also shown how costly group B Strep infections are in financial
terms during the first two years of life16, with some survivors suffering life-long
problems. In addition, the reducing costs of sensitive testing and the rising
incidence of GBS infection in newborns mean that this cost-effectiveness is
increasing. One estimate is a net benefit to the Government of such an
approach of around £37million per year17.
9
Health Protection Agency’s Bacteriology Standard Operating Procedure No 58 - Processing Swabs for Group B Streptococcal Carriage.
Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B
streptococcal colonization at delivery. Obstet Gynecol 1996; 88(5):811-815.
11 Jordan HT, Farley MM, Craig A, Mohle-Boetani J, Harrison LH, Petit S et al (2008) Revisiting the need for vaccine prevention of late-onset neonatal
group B streptococcal disease: a multistate, population-based analysis. Pediatr Infect Dis J 27(12): 1057–64
12 : J Med Screen. Maternal screening to prevent neonatal Group B streptococcal disease. Journal of Medical Screening 2002; 9(4). Also Steer PJ, Plumb
J. Myth: Group B streptococcal infection in pregnancy: Comprehended and conquered. Semin Fetal Neonatal Med 2011. McCartney AC. Prevention of
early onset neonatal Group B Streptococcal infection. J Med Screen 2001; 2001; 8(4):170-172
13 Prenatal screening and treatment strategies to prevent Group B Streptococcal and other bacterial infections in early infancy: cost-effectiveness and
expected value of information analyses. HTA. August 2007. T Colbourn, C Asseburg, L Bojke, Z Philips, K Claxton, AE Ades and RE Gilbert)
14 Cost-effectiveness of rapid tests and other existing strategies for screening and management of early onset group B Streptococcus during labour. Brit
J Obstet Gynaec. November 2010. B Kaambwa, S Bryan, J Gray, P Milner, J Daniels, KS Khan, TE Roberts)
15 Daniels J, Gray J, Pattison H, Gray R, Hills R, Khan K on behalf of the GBS Collaborative Group. Intrapartum tests for group B
Streptococcus: accuracy and acceptability of screening. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02725.x.
16 The economic costs of Group B Streptococcus (GBS) disease: prospective cohort study of infants with GBS disease in England. Eur J Health Econ.
November 2008. Elizabeth-Ann Schroeder, Stavros Petrou, Gail Balfour, Oya Edamma, Paul T Heath on behalf of the Health Protection Agency Group B
Streptococcus Working Group.
17 Prenatal screening and treatment strategies to prevent Group B Streptococcal and other bacterial infections in early infancy: cost-effectiveness and
expected value of information analyses. HTA. August 2007. T Colbourn, C Asseburg, L Bojke, Z Philips, K Claxton, AE Ades and RE Gilbert
10
Group B Strep Support, PO Box 203, Haywards Heath, West Sussex RH16 1GF
E-mail: jplumb@gbss.org.uk
Tel: 01444 416176
Fax: 0870 803 0024
Registered Charity No: 1112065 Registered Co No: 5587535
20 January 2012
What action can be
taken?
What can you do to
help make this
happen?
Contact information for
Group B Strep Support
The current risk factor approach is poorly adhered to18, with an unacceptably
high number of missed opportunities for preventing GBS infections in babies.
 All relevant health professionals should be fully informed about GBS
 Every pregnant woman should be given clear and accurate information
on GBS as a routine part of her antenatal care
 The NHS should cease to use the ‘standard’ test for the detection of GBS
carriage in pregnancy and replace it with tests that offer good sensitivity
for detecting GBS
 Sensitive testing for GBS should be made freely available within the NHS
to every low-risk pregnant woman
 The RCOG GBS guidelines should be fully implemented in all maternity
units and policy and practice regularly audited against these guidelines
 Every higher-risk pregnant woman (with only one risk factor) should be
offered intravenous antibiotics from the start of labour to delivery
 Every high-risk pregnant woman (with more than one risk factor) should
be recommended intravenous antibiotics from the start of labour until
delivery.
 Research into a vaccine against GBS should be supported.
 Write to the Secretary of State for Health asking for a review of
screening for GBS
 Ask your local NHS what procedures they have in place to inform
mothers about GBS
 Ask your local NHS when they test for GBS and what test do they use
 Sign the on line petition at
http://epetitions.direct.gov.uk/petitions/4854
Group B Strep Support, PO Box 203, Haywards Heath, West Sussex RH16 1GF.
Telephone: 01444 416176
Email: JPlumb@GBSS.org.uk
Website: www.gbss.org.uk
18
Missed opportunities for preventing GBS infections, Arch Dis Child Fetal Neonatal Ed 12 May 2009. S Vergnano, N D Embleton, A Collinson, E Menson,
AR Bedford Russell & PT Heath.
Group B Strep Support, PO Box 203, Haywards Heath, West Sussex RH16 1GF
E-mail: jplumb@gbss.org.uk
Tel: 01444 416176
Fax: 0870 803 0024
Registered Charity No: 1112065 Registered Co No: 5587535
20 January 2012