Group B Streptococcal disease in England (1998 - 2017): a population based observational study.
Kadambari S., Trotter CL., Heath PT., Goldacre MJ., Pollard AJ., Goldacre R.
BACKGROUND AND OBJECTIVES: Group B Streptococcus (GBS) is the leading cause of sepsis and meningitis in infants <90 days. In this study, the burden of GBS disease and mortality in young infants in England was assessed. METHODS: Using linked hospitalisation records from every National Health Service (NHS) hospital from 1 April 1998 to 31 March 2017, we calculated annual GBS incidence in infants aged <90 days and, using regression models, compared their perinatal factors, rates of hospital-recorded disease outcomes and all-cause infant mortality rates with those of the general infant population. RESULTS: 15,429 infants aged <90 days had a hospital-recorded diagnosis of GBS, giving an average annual incidence of 1.28 per 1000 live births (95% CI 1.26-1.30) with no significant trend over time. GBS-attributable mortality declined significantly from 0.044 (95%CI 0.029-0.065) per 1000 live births in 2001 to 0.014 (95%CI 0.010-0.026) in 2017 (annual percentage change -6.6, 95%CI -9.1 to -4.0). Infants with GBS had higher relative rates of visual impairment (HR 7.0 95% CI 4.1-12.1), cerebral palsy (HR 9.3 95% CI 6.6-13.3), hydrocephalus (HR 17.3 95% CI 13.8-21.6) and NEC (HR 18.8 95% CI 16.7-21.2) compared with those without GBS. CONCLUSIONS: Annual rates of GBS disease in infants have not changed over 19 years. The reduction in mortality is likely multifactorial and due to widespread implementation of antibiotics in at-risk mothers and babies as well as advances in managing acutely unwell infants. New methods for prevention, such as maternal vaccination, must be prioritised.