Risk factors for invasive Group B <i>Streptococcal</i> (GBS) disease in early-onset and late-onset disease cases and matched controls.

<p>¹Univariate-OR(95%CI)-calculated odds ratio with 95% confidence using Fischer exact test comparing cases and controls.</p><p>² Multivariate-OR(95%CI)-calculated odds ratio with 95% confidence of disease using conditional logistic regression (For early-onset disease: adjusted for HIV-status, maternal age at delivery, gestational age, maternal GBS colonization, prolonged ROM, offensive liquor, maternal temperature>38, GBS bacteriuria and any intra-partum antibiotics. For late-onset disease: adjusted for HIV-status, maternal age at delivery, gestational age, maternal GBS colonization and GBS bacteriuria).</p><p>³ Prolonged ROM (>18 hours)-prolonged rupture of membranes.</p><p>⁴Maternal fever during labor.</p><p>⁵IAP-Intrapartum antibiotic prophylaxis to pregnant women that met risk-based criteria (gestation <37 weeks, PROM and maternal intra-partum fever).</p><p>Risk factors for invasive Group B <i>Streptococcal</i> (GBS) disease in early-onset and late-onset disease cases and matched controls.</p

Demographic characteristics of infants with invasive Group B <i>Streptococcal</i> (GBS) disease.

<p>¹EOD-Early-onset disease.</p><p>²LOD-Late-onset disease.</p><p>³OR(95%CI)-calculated odds ratio with 95% confidence comparing EOD to LOD.</p><p>⁴p-value-using Chi-squared, Fischer exact or Wilcoxon rank-sum (Mann-Whitney) test.</p><p>⁵CSF-Cerebrospinal fluid.</p><p>Demographic characteristics of infants with invasive Group B <i>Streptococcal</i> (GBS) disease.</p

Flow Diagram of study participation.

<div><p>Diagram indicating number of children enrolled into the study and number excluded or lost to follow-up during the course of the study.</p> <p>Withdrew consent = participant no longer wished to be part of study cohort and preferred to be vaccinated at local clinic. Relocated=participant moved out of study area and therefore unable to attend study visits. Lost to follow up = study site unable to contact study participant. Outside window period = vaccination occurred outside protocol defined period of 6-12 weeks; 12-24 weeks and 38-42 weeks for the first, second and third doses respectively. PCV= 7-valent Pneumococcal Conjugate Vaccine.</p></div

Proportion of infants with IgG concentrations of ≥ 35µg/ml following 2 and 3 doses of PCV-7.

<div><p>The proportion of infants with serum anti-capsular IgG antibody concentration ≥ 35µg/ml, a putative measure of protection against invasive pneumococcal disease, following vaccination with PCV-7. Vaccine was administered at 6,10 and 14 weeks of age or at 6,14 and 40 weeks of age. Antibody concentrations were assessed after the second and after the third dose in the series.</p> <p>PCV-7= 7-valent Pneumococcal Conjugate Vaccine, IgG = Immunoglobulin G.</p></div

Burden of Invasive Group B <i>Streptococcus</i> Disease and Early Neurological Sequelae in South African Infants

<div><p>Introduction</p><p>Group B <i>Streptococcus</i> (GBS) is a leading cause of neonatal sepsis and meningitis. We aimed to evaluate the burden of invasive early-onset (0–6 days of life, EOD) and late-onset (7–89 days, LOD) GBS disease and subsequent neurological sequelae in infants from a setting with a high prevalence (29.5%) of HIV among pregnant women.</p><p>Methods</p><p>A case-control study was undertaken at three secondary-tertiary care public hospitals in Johannesburg. Invasive cases in infants <3 months age were identified by surveillance of laboratories from November 2012 to February 2014. Neurodevelopmental screening was done in surviving cases and controls at 3 and 6 months of age.</p><p>Results</p><p>We identified 122 cases of invasive GBS disease over a 12 month period. Although the incidence (per 1,000 live births) of EOD was similar between HIV-exposed and HIV-unexposed infants (1.13 vs. 1.46; p = 0.487), there was a 4.67-fold (95%CI: 2.24–9.74) greater risk for LOD in HIV-exposed infants (2.27 vs. 0.49; p<0.001). Overall, serotypes Ia, Ib and III constituted 75.8% and 92.5% of EOD and LOD, respectively. Risk factors for EOD included offensive draining liquor (adjusted Odds Ratio: 27.37; 95%CI: 1.94–386.50) and maternal GBS bacteriuria (aOR: 8.41; 95%CI: 1.44–49.15), which was also a risk-factor for LOD (aOR: 3.49; 95%CI: 1.17–10.40). The overall case fatality rate among cases was 18.0%. The adjusted odds for neurological sequelae at 6 months age was 13.18-fold (95%CI: 1.44–120.95) greater in cases (13.2%) than controls (0.4%).</p><p>Discussion</p><p>The high burden of invasive GBS disease in South Africa, which is also associated with high case fatality rates and significant neurological sequelae among survivors, is partly due to the heightened risk for LOD in infants born to HIV-infected women. An effective trivalent GBS conjugate vaccine targeted at pregnant women could prevent invasive GBS disease in this setting.</p></div

Predictors of mortality from invasive Group B streptococcus (GBS) disease.

<p>¹OR(95%CI)-calculated odds ratio with 95% confidence comparing infants that demised versus survivors of GBS disease using Chi-squared or Fischer exact test.</p><p>² Multivariate-OR(95%CI)-calculated odds ratio with 95% confidence using logistic regression (adjusted for timing of disease, HIV-exposure, prematurity (<34 weeks), ventilation, inotropic support, apnea, seizures).</p><p>³WCC-White cell count.</p><p>⁴CRP-C-reactive protein.</p><p>Predictors of mortality from invasive Group B streptococcus (GBS) disease.</p