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Davi SD, Okwu DG, Luetgehetmann M, Abba FM, Aepfelbacher M, Endamne LR, Alabi A, Zoleko-Manego R, Mombo-Ngoma G, Mahmoudou S, Addo MM, Ramharter M, Mischlinger J. Epidemiology of co-infections in pregnant women living with human immunodeficiency virus 1 in rural Gabon: a cross-sectional study. Infect Dis Poverty 2023; 12:64. [PMID: 37408012 DOI: 10.1186/s40249-023-01114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND There is no recent epidemiological data on HIV infection in Gabon, particularly in pregnant women. To close this gap, an HIV-prevalence survey was conducted among Gabonese pregnant women, followed by a cross-sectional case-control study in which the prevalence of various co-infections was compared between HIV-positive and HIV-negative pregnant women. METHODS Between 2018 and 2019, data for the HIV-prevalence survey were collected retrospectively in 21 Gabonese antenatal care centres (ANCs). Subsequently, for the prospective co-infection study, all HIV-positive pregnant women were recruited who frequented the ANC in Lambaréné and a comparator sub-sample of HIV-negative pregnant women was recruited; these activities were performed from February 2019 to February 2020. The mean number of co-infections was ascertained and compared between HIV-positive and HIV-negative women. Additionally, the odds for being co-infected with at least one co-infection was evaluated and compared between HIV-positive and HIV-negative women. RESULTS HIV-positivity was 3.9% (646/16,417) among pregnant women. 183 pregnant women were recruited in the co-infection study. 63% of HIV-positive and 75% of HIV-negative pregnant women had at least one co-infection. There was a trend indicating that HIV-negative women were more often co-infected with sexually transmitted infections (STIs) than HIV-positive women [mean (standard deviation, SD): 2.59 (1.04) vs 2.16 (1.35), respectively; P = 0.056]; this was not the case for vector-borne infections [mean (SD): 0.47 (0.72) vs 0.43 (0.63), respectively; P = 0.59]. CONCLUSIONS Counterintuitively, the crude odds for concomitant STIs was lower in HIV-positive than in HIV-negative women. The change of magnitude from the crude to adjusted OR is indicative for a differential sexual risk factor profile among HIV-positive and HIV-negative women in this population. This might potentially be explained by the availability of sexual health care counselling for HIV-positive women within the framework of the national HIV control programme, while no such similar overall service exists for HIV-negative women. This highlights the importance of easy access to sexual healthcare education programmes for all pregnant women irrespective of HIV status.
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Affiliation(s)
- Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marc Luetgehetmann
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Martin Aepfelbacher
- Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ayodele Alabi
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Department of Parasitology, Leiden University Medical Center, Albinusdreef, The Netherlands
| | | | - Ghyslain Mombo-Ngoma
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | - Marylyn Martina Addo
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Department for Clinical Immunology of Infectious Diseases and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Johannes Mischlinger
- Centre of Tropical Medicine, Bernhard-Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- German Centre for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
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2
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Hanson L, VandeVusse L, Forgie M, Malloy E, Singh M, Scherer M, Kleber D, Dixon J, Hryckowian AJ, Safdar N. A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms. Am J Obstet Gynecol MFM 2023; 5:100748. [PMID: 36108911 DOI: 10.1016/j.ajogmf.2022.100748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Probiotics have been suggested as a strategy to reduce antenatal group B Streptococcus colonization. Although probiotics are known to improve gastrointestinal symptoms, this has not been studied during pregnancy. OBJECTIVE This study aimed to evaluate the efficacy of a probiotic to reduce: (1) standard-of-care antenatal group B Streptococcus colonization and colony counts and (2) gastrointestinal symptoms of pregnancy. STUDY DESIGN In a double-blind fashion, 109 healthy adult pregnant people were randomized to Florajen3 probiotic or placebo capsules once daily from 28 weeks' gestation until labor onset. Baseline vaginal and rectal study swabs for group B Streptococcus colony-forming units and microbiome analysis were collected at 28 and 36 weeks' gestation. Standard-of-care vaginal to rectal group B Streptococcus swabs were collected from all participants at 36 weeks' gestation and determined the need for intrapartum antibiotic prophylaxis. Data collection included solicitation of adverse events, demographic information, Antepartum Gastrointestinal Symptom Assessment score, yogurt ingestion, sexual activity, and vaginal cleaning practices. RESULTS A total of 83 participants completed the study to 36 weeks' gestation with no adverse events. Standard-of-care group B Streptococcus colonization was 20.4% in the control group and 15.4% in probiotic group participants (-5%; P=.73). The relative risk for positive standard-of-care vaginal-rectal group B Streptococcus colonization was 1.33 (95% confidence interval, 0.5-3.40) times higher in the control group than in the probiotic group (P=.55). There were no differences in median vaginal (P=.16) or rectal (P=.20) group B streptococcus colony-forming units at baseline or at 36 weeks (vaginal P>.999; rectal P=.56). Antepartum Gastrointestinal Symptom Assessment scores were similar at baseline (P=.19), but significantly decreased in probiotic group participants at 36 weeks (P=.02). No covariates significantly altered group B Streptococcus colonization. Significantly more Florajen3 bacteria components were recovered from the vaginal-rectal samples of probiotic group participants (32%; P=.04) compared with controls. CONCLUSION The findings of this study provided insufficient evidence for the clinical application of the Florajen3 probiotic intervention to reduce standard-of-care vaginal-rectal group B Streptococcus colonization. The prevalence of group B Streptococcus was lower than expected in the study population, and intervention adherence was poor. Probiotic bacteria colonization of the genitourinary tract occurred more in intervention group participants than in controls and significantly reduced gastrointestinal symptoms of pregnancy.
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Affiliation(s)
- Lisa Hanson
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh).
| | - Leona VandeVusse
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh)
| | - Marie Forgie
- Advocate Aurora UW Medical Group, Aurora Sinai Medical Center, Milwaukee, WI (Drs Forgie and Malloy)
| | - Emily Malloy
- Advocate Aurora UW Medical Group, Aurora Sinai Medical Center, Milwaukee, WI (Drs Forgie and Malloy); Advocate Aurora Sinai Midwifery and Wellness Center, Milwaukee, WI (Dr Malloy and Ms Scherer)
| | - Maharaj Singh
- Marquette University College of Nursing, Milwaukee, WI (Drs Hanson, VandeVusse, Malloy, and Singh); Advocate Aurora Research Institute, Milwaukee, WI (Dr Singh and Ms Kleber)
| | - MaryAnne Scherer
- Advocate Aurora Sinai Midwifery and Wellness Center, Milwaukee, WI (Dr Malloy and Ms Scherer)
| | - Diana Kleber
- Advocate Aurora Research Institute, Milwaukee, WI (Dr Singh and Ms Kleber)
| | - Jonah Dixon
- University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr Dixon and Dr Safdar)
| | - Andrew J Hryckowian
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin-Madison, Madison, WI (Dr Hryckowian); Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI (Dr Hryckowian)
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr Dixon and Dr Safdar)
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Mikomangwa WP, Minzi O, Mutagonda R, Baraka V, Mlugu EM, Aklillu E, Kamuhabwa AAR. Effect of sulfadoxine-pyrimethamine doses for prevention of malaria during pregnancy in hypoendemic area in Tanzania. Malar J 2020; 19:160. [PMID: 32306955 PMCID: PMC7168863 DOI: 10.1186/s12936-020-03234-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria in pregnancy increases the risk of deleterious maternal and birth outcomes. The use of ≥ 3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (IPTp-SP) is recommended for preventing the consequences of malaria during pregnancy. This study assessed the effect of IPTp-SP for prevention of malaria during pregnancy in low transmission settings. METHODS A cross-sectional study that involved consecutively selected 1161 pregnant women was conducted at Mwananyamala regional referral hospital in Dar es Salaam. Assessment of the uptake of IPTp-SP was done by extracting information from antenatal clinic cards. Maternal venous blood, cord blood, placental blood and placental biopsy were collected for assessment of anaemia and malaria. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was used to detect and quantify sulfadoxine (SDX). Dried blood spots (DBS) of placental blood were collected for determination of sub-microscopic malaria using polymerase chain reaction (PCR). RESULTS In total, 397 (34.2%) pregnant women reported to have used sub-optimal doses (≤ 2) while 764 (65.8%) used optimal doses (≥ 3) of IPTp-SP at the time of delivery. The prevalence of placental malaria as determined by histology was 3.6%. Submicroscopic placental malaria was detected in 1.4% of the study participants. Women with peripheral malaria had six times risk of maternal anaemia than those who were malaria negative (aOR, 5.83; 95% CI 1.10-30.92; p = 0.04). The geometric mean plasma SDX concentration was 10.76 ± 2.51 μg/mL. Sub-optimal IPTp-SP dose was not associated with placental malaria, premature delivery and fetal anaemia. The use of ≤ 2 doses of IPTp-SP increased the risk of maternal anaemia by 1.36-fold compared to ≥ 3 doses (aOR, 1.36; 95% CI 1.04-1.79; p = 0.02). CONCLUSION The use of < 2 doses of IPTp-SP increased the risk of maternal anaemia. However, sub-optimal doses (≤ 2 doses) were not associated with increased the risk of malaria parasitaemia, fetal anaemia and preterm delivery among pregnant women in low malaria transmission setting. The use of optimal doses (≥ 3 doses) of IPTp-SP and complementary interventions should continue even in areas with low malaria transmission.
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Affiliation(s)
- Wigilya P Mikomangwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.
| | - Omary Minzi
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Ritah Mutagonda
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Vito Baraka
- National Institute for Medical Research, Tanga Centre, Tanga, United Republic of Tanzania
| | - Eulambius M Mlugu
- Pharmaceutics and Pharmacy Practice Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge C1:68, 141 86, Stockholm, Sweden
| | - Appolinary A R Kamuhabwa
- Clinical Pharmacy and Pharmacology Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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4
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Patras KA, Nizet V. Group B Streptococcal Maternal Colonization and Neonatal Disease: Molecular Mechanisms and Preventative Approaches. Front Pediatr 2018; 6:27. [PMID: 29520354 PMCID: PMC5827363 DOI: 10.3389/fped.2018.00027] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) colonizes the gastrointestinal and vaginal epithelium of a significant percentage of healthy women, with potential for ascending intrauterine infection or transmission during parturition, creating a risk of serious disease in the vulnerable newborn. This review highlights new insights on the bacterial virulence determinants, host immune responses, and microbiome interactions that underpin GBS vaginal colonization, the proximal step in newborn infectious disease pathogenesis. From the pathogen perspective, the function GBS adhesins and biofilms, β-hemolysin/cytolysin toxin, immune resistance factors, sialic acid mimicry, and two-component transcriptional regulatory systems are reviewed. From the host standpoint, pathogen recognition, cytokine responses, and the vaginal mucosal and placental immunity to the pathogen are detailed. Finally, the rationale, efficacy, and potential unintended consequences of current universal recommended intrapartum antibiotic prophylaxis are considered, with updates on new developments toward a GBS vaccine or alternative approaches to reducing vaginal colonization.
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Affiliation(s)
- Kathryn A Patras
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Victor Nizet
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
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5
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Slotved HC, Dayie NTKD, Banini JAN, Frimodt-Møller N. Carriage and serotype distribution of Streptococcus agalactiae in third trimester pregnancy in southern Ghana. BMC Pregnancy Childbirth 2017; 17:238. [PMID: 28732495 PMCID: PMC5520380 DOI: 10.1186/s12884-017-1419-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the prevalence of Streptococcus agalactiae (group B streptococci, GBS) among healthy, pregnant women attending antenatal care at different study sites in the Greater Accra Region, Ghana. METHODS Between 2010 and June 2013, recto-vaginal swab samples were collected from pregnant women attending antenatal care from two study sites in southern Ghana. The samples were collected within 35 and 37 weeks of the gestation period. These were inoculated into Todd-Hewitt broth followed by sub-culturing onto a sheep-blood agar plate. Identification was performed on a single subcultured colony. Gram staining was performed, and isolates were evaluated for beta-haemolytic reactions. Furthermore, the isolates were serotyped using the GBS latex serotyping kit. RESULTS The carriage rates were found to be 25.5% (95% CI: 19.6-32.1) to 28.0% (95% CI: 21.9-34.8) for the two collection sites. The most common serotypes were serotypes VII and IX. The data showed that women below 20 years of age or above 30 years of age have a significantly (p = 0.037) higher risk of carrying GBS compared to women from the age group of 20 to 30 years. CONCLUSIONS The findings of this study revealed that prevalence of GBS colonization in pregnant women in Greater Accra region is high and comparable to rates observed in South Africa and Western countries. The most prevalent serotypes were serotypes VII and IX, which have not been observed before in West Africa.
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Affiliation(s)
- Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, -2300, Copenhagen, DK, Denmark.
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Josephine A N Banini
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, University Hospital, Hvidovre, Copenhagen, Denmark
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6
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Belard S, Toepfner N, Capan-Melser M, Mombo-Ngoma G, Zoleko-Manego R, Groger M, Matsiegui PB, Agnandji ST, Adegnika AA, González R, Kremsner PG, Menendez C, Ramharter M, Berner R. Streptococcus agalactiae Serotype Distribution and Antimicrobial Susceptibility in Pregnant Women in Gabon, Central Africa. Sci Rep 2015; 5:17281. [PMID: 26603208 PMCID: PMC4658565 DOI: 10.1038/srep17281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/28/2015] [Indexed: 11/17/2022] Open
Abstract
Neonatal invasive disease due to Streptococcus agalactiae is life threatening and preventive strategies suitable for resource limited settings are urgently needed. Protective coverage of vaccine candidates based on capsular epitopes will relate to local epidemiology of S. agalactiae serotypes and successful management of critical infections depends on timely therapy with effective antibiotics. This is the first report on serotype distribution and antimicrobial susceptibility of S. agalactiae in pregnant women from a Central African region. Serotypes V, III, and Ib accounted for 88/109 (81%) serotypes and all isolates were susceptible to penicillin and clindamycin while 13% showed intermediate susceptibility to erythromycin.
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Affiliation(s)
- Sabine Belard
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Toepfner
- Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mesküre Capan-Melser
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Département de Parasitologie, Université des Sciences de la Santé, Libreville, Gabon
| | - Rella Zoleko-Manego
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Ngounie Medical Research Centre, Fougamou, Gabon
| | - Mirjam Groger
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Selidji T Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Ayôla A Adegnika
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Raquel González
- ISGlobal, Barcelona Ctr. Int. Health Res (CRESIB), Hospital Clínic- Universitat de Barcelona), Barcelona, Spain
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Clara Menendez
- ISGlobal, Barcelona Ctr. Int. Health Res (CRESIB), Hospital Clínic- Universitat de Barcelona), Barcelona, Spain
| | - Michael Ramharter
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard Berner
- Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Iroh Tam PY, Delair SF, Obaro SK. Neonatal group B streptococcus disease in developing countries: are we ready to deploy a vaccine? Expert Rev Vaccines 2015; 14:1401-3. [PMID: 26289974 DOI: 10.1586/14760584.2015.1077121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Group B streptococcus (GBS) disease is the leading cause of neonatal sepsis in developed countries and has high case fatality rates. In developing countries, however, the burden of GBS is less clear; this is due to a lack of studies using optimal diagnostic, clinical and laboratory techniques and is complicated by the wide availability of non-prescription antibiotics to the general population and in peripartum patients. There is an urgent need for prospective, population-based surveillance to provide an accurate assessment of neonatal GBS disease burden in developing countries, which remains largely unrecognized, and consequently obscures the potential relevance of GBS vaccination in these populations. Preliminary data on GBS vaccines are promising as a preventive tool for neonatal GBS infection, more so than any other currently available public health initiative. However, how do we assess the true impact of a GBS vaccine without accurate surveillance data on the real burden of disease?
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Affiliation(s)
- Pui-Ying Iroh Tam
- a 1 University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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