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January 14, 2019

Preventing Neonatal Group B Streptococcus Disease: The Limits of Success

Author Affiliations
  • 1Division of Neonatology, Children’s Hospital of Philadelphia, Pennsylvania
  • 2Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia
  • 3University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Pediatr. 2019;173(3):219-220. doi:10.1001/jamapediatrics.2018.4824

More than 2 decades have passed since the first guidelines for preventing perinatal group B Streptococcus (GBS) disease were published from the Centers for Disease Control and Prevention with consensus from the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. The currently recommended practices are based on the routine screening of pregnant women for vaginal/rectal colonization with GBS, with intrapartum antibiotic prophylaxis (IAP) to reduce vertical GBS transmission and subsequent invasive disease in the infant.1 Surveillance in the United States in 1990 revealed that approximately 1.4 cases of neonatal GBS early-onset disease (EOD) occurred for every 1000 live births.2 The study by Nanduri et al3 in this issue of JAMA Pediatrics reveals a substantial decrease in GBS EOD among American infants over the past 10 years. Using data from the Centers for Disease Control and Prevention Active Bacterial Core surveillance, this study reveals progressive declines in incidence from 0.37 cases per 1000 live births in 2006 to 0.23 cases per 1000 live births in 2015. Among infants born at 37 weeks’ gestation or older, fewer than 2 cases per 10 000 live births occurred in 2015. Although improvements in obstetric practices may also contribute, perinatal GBS prevention guidelines are considered a major driver for the decline of GBS EOD in the United States.