Le Doare Kirsty, Kampmann Beate
Imperial College London, Department of Paediatrics, St. Mary's Hospital, Praed Street, London, W2 1NY, UK; Wellcome Trust Centre for Global Health Research, Norfolk Place, London, UK; MRC Unit, Vaccinology Theme, Atlantic Road, Fajara, The Gambia.
Imperial College London, Department of Paediatrics, St. Mary's Hospital, Praed Street, London, W2 1NY, UK; MRC Unit, Vaccinology Theme, Atlantic Road, Fajara, The Gambia.
Vaccine. 2014 May 30;32(26):3128-32. doi: 10.1016/j.vaccine.2014.04.020. Epub 2014 Apr 13.
Invasive Group-B streptococcal (GBS) disease is a leading cause of infant mortality and morbidity worldwide. GBS colonises the maternal rectum and vagina and transmission of bacteria from a colonized mother to her infant at birth is an important risk factor for GBS disease. GBS disease has also been associated with case reports of transmission via infected breast milk raising questions about mode of acquisition and transmission of this enteric pathogen and the development of neonatal disease. However, most breastfed infants remain unaffected by GBS in breast milk. Mechanisms associated with transmission of GBS in breast milk and potential factors that may protect the infant from transmission remain poorly understood. Understanding factors involved in protection or transmission of GBS infection via breast milk is important both for premature infants who are a high-risk group and for infants in the developing world where breastfeeding is the only sustainable infant feeding option. In this review we discuss the proposed mechanisms for GBS colonization in breast milk on one hand and its immune factors that may protect from transmission of GBS from mother to infant on the other. Innate and adaptive immune factors, including serotype-specific antibody and their significance in the prevention of infant disease are presented. We further report on the role of human oligosaccharides in protection from invasive GBS disease. Advances in our knowledge about breast milk and immunity in GBS disease are needed to fully appreciate what might mitigate transmission from mother to infant and protect neonates from this devastating disease and to contribute to the development of novel prevention strategies, including maternal immunization to prevent infant disease.
侵袭性B族链球菌（GBS）疾病是全球婴儿死亡和发病的主要原因。GBS定殖于母体直肠和阴道，出生时细菌从定殖的母亲传播给婴儿是GBS疾病的一个重要危险因素。GBS疾病还与通过受感染母乳传播的病例报告有关，这引发了关于这种肠道病原体的感染和传播方式以及新生儿疾病发展的问题。然而，大多数母乳喂养的婴儿不会受到母乳中GBS的影响。与母乳中GBS传播相关的机制以及可能保护婴儿免受传播的潜在因素仍知之甚少。了解通过母乳传播GBS感染的保护或传播因素，对于作为高危群体的早产儿以及母乳喂养是唯一可持续婴儿喂养方式的发展中国家的婴儿都很重要。在这篇综述中，我们一方面讨论了GBS在母乳中定殖的推测机制，另一方面讨论了可能保护婴儿免受GBS从母亲传播的免疫因素。介绍了先天性和适应性免疫因素，包括血清型特异性抗体及其在预防婴儿疾病中的意义。我们还进一步报告了人乳寡糖在预防侵袭性GBS疾病中的作用。需要在我们对母乳和GBS疾病免疫方面的知识上取得进展，以充分了解哪些因素可能减轻从母亲到婴儿的传播并保护新生儿免受这种毁灭性疾病的侵害，并有助于制定新的预防策略，包括通过母体免疫来预防婴儿疾病。
