2014-15 年英国和爱尔兰 90 天以下婴儿 B 群链球菌病：一项前瞻性监测研究。

Group B streptococcal disease in UK and Irish infants younger than 90 days, 2014-15: a prospective surveillance study.

机构信息

Paediatric Infectious Diseases Research Group & Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK.

National Infection Service, Public Health England, London, UK.

出版信息

Lancet Infect Dis. 2019 Jan;19(1):83-90. doi: 10.1016/S1473-3099(18)30555-3. Epub 2018 Nov 26.

DOI:10.1016/S1473-3099(18)30555-3

PMID:30497953

Abstract

BACKGROUND

Group B streptococcus is a leading cause of serious infection in young infants in many countries worldwide. We aimed to define the burden and clinical features of invasive group B streptococcal disease in infants younger than 90 days in the UK and Ireland, together with the characteristics of disease-causing isolates.

METHODS

Prospective, active national surveillance of invasive group B streptococcal disease in infants younger than 90 days was done from April 1, 2014, to April 30, 2015, through the British Paediatric Surveillance Unit, microbiology reference laboratories, and national public health agencies in the UK and Ireland. Early onset was defined as disease in the first 6 days of life and late onset was defined as 7-89 days of life. Incidence was calculated using livebirths in 2014 (after adjustment for the 13-month surveillance period). Isolates were characterised by serotyping, multilocus sequence typing, and antimicrobial susceptibility testing.

FINDINGS

856 cases of group B streptococcus were identified in 2014-15, an incidence of 0·94 per 1000 livebirths (95% CI 0·88-1·00). Incidence for early-onset disease (n=517) was 0·57 per 1000 livebirths (95% CI 0·52-0·62), and for late-onset disease (n=339) was 0·37 per 1000 livebirths (0·33-0·41). 53 infants died (case fatality rate 6·2%), of whom 27 had early-onset disease (case fatality rate 5·2%) and 26 had late-onset disease (case fatality rate 7·7%). The predominant serotypes were III (241 [60%] of 402 serotyped isolates) and Ia (69 [17%]); five serotypes (Ia, Ib, II, III, V) accounted for 377 (94%) of all serotyped isolates.

INTERPRETATION

The incidence of invasive infant group B streptococcal disease in the UK and Ireland has increased since a comparable study done in 2000-01. The burden of early-onset disease has not declined despite the introduction of national prevention guidelines. New strategies for prevention are required.

FUNDING

Meningitis Now.

摘要

背景

B 群链球菌是世界上许多国家导致婴幼儿严重感染的主要原因。我们旨在确定英国和爱尔兰 90 天以下婴儿侵袭性 B 群链球菌病的负担和临床特征，以及致病分离株的特征。

方法

2014 年 4 月 1 日至 2015 年 4 月 30 日，通过英国儿科监测单位、微生物学参考实验室和英国及爱尔兰的国家公共卫生机构，对 90 天以下的侵袭性 B 群链球菌病进行了前瞻性、主动的全国性监测。早发性疾病定义为生命的头 6 天内发病，晚发性疾病定义为 7-89 天发病。发病率按 2014 年活产数计算（调整了 13 个月的监测期）。通过血清分型、多位点序列分型和抗菌药物敏感性试验对分离株进行了特征描述。

结果

2014-15 年共发现 856 例 B 群链球菌，发病率为每 1000 例活产儿 0.94 例（95%CI0.88-1.00）。早发性疾病（n=517）的发病率为每 1000 例活产儿 0.57 例（95%CI0.52-0.62），晚发性疾病（n=339）的发病率为每 1000 例活产儿 0.37 例（0.33-0.41）。53 例婴儿死亡（病死率 6.2%），其中 27 例为早发性疾病（病死率 5.2%），26 例为晚发性疾病（病死率 7.7%）。主要血清型为 III 型（402 例血清分型分离株中有 241 株[60%]）和 Ia 型（69 株[17%]）；五种血清型（Ia、Ib、II、III、V）占所有血清分型分离株的 377 株（94%）。