Mahtab Sana, Madewell Zachary J, Madhi Shabir A, Wise Amy, Swart Peter J, Velaphi Sithembiso, Mandomando Inacio, Bramugy Justina, Mabunda Rita, Xerinda Elisio, Scott Anthony G, Assefa Nega, Madrid Lola, Bweihun Mulu, Temesgen Fikremelekot, Onyango Dickens, Akelo Victor, Oliech Richard, Otieno Peter, Verani Jennifer R, Arifeen Shams El, Gurley Emily S, Alam Muntasir, Rahman Afruna, Hossain Mohammad Zahid, Sow Samba, Kotloff Karen, Tapia Milagritos, Keita Adama Mamby, Sanogo Doh, Ogbuanu Ikechukwu, Ojulong Julius, Lako Sandra, Ita Okokon, Kaluma Erick, Wilson Tais, Mutevedzi Portia, Barr Beth A Tippett, Whitney Cynthia G, Blau Dianna M, Bassat Quique
South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Open Forum Infect Dis. 2023 Jul 11;10(9):ofad356. doi: 10.1093/ofid/ofad356. eCollection 2023 Sep.
Invasive Group B (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS).
Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death.
We evaluated 2966 deaths, including stillborn infants ( = 1322), infants who died during first day of life (0 to <24 hours, = 597), early neonatal deaths (END) (1 day to <7 days; END; = 593), and deaths from 7 to 90 days ( = 454). Group B was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48).
Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
B族链球菌（GBS）侵袭性感染是早发型新生儿败血症的常见病因，也与死产有关。本研究旨在通过参与儿童健康与死亡率预防监测（CHAMPS）的7个低收入和中等收入国家（LMICs）进行的尸检微创组织采样（MITS），确定GBS导致的死产婴儿以及出生后0至90天内死亡婴儿的比例。
对2016年12月至2021年12月期间发生的死亡病例进行MITS调查，包括血液和脑脊液（CSF）细菌培养、血液、CSF和肺组织的多病原体聚合酶链反应以及肺、肝和脑的组织病理学检查。数据收集包括临床记录审查和口头尸检。专家小组审查了所有信息并确定死亡原因。
我们评估了2966例死亡病例，包括死产婴儿（n = 1322）、出生第一天（0至<24小时，n = 597）死亡的婴儿、早期新生儿死亡（END）（1天至<7天；END；n = 593）以及7至90天死亡的婴儿（n = 454）。确定GBS在2.7%的婴儿死亡原因中起作用（2966例中的79例；范围从塞拉利昂的0.3%到南非的7.2%），包括2.3%（1322例中的31例）的死产、4.7%（597例中的28例）0至<24小时死亡、1.9%（593例中的11例）END以及2.0%（454例中的9例）7至90天龄死亡。在有出生体重数据的GBS归因死亡病例中，61.9%（63例中的39例）的死者出生时体重<2500克。B族链球菌败血症是100%（31例中的31例）死产的尸检诊断。对于<90天的死亡病例，尸检诊断包括GBS败血症（83.3%，48例中的40例）、GBS脑膜炎（4.2%，48例中的2例）和GBS肺炎（2.1%，48例中的1例）。
我们的研究揭示了不同国家侵袭性GBS疾病对婴儿死亡率影响的显著异质性，强调了制定针对性预防策略的必要性。此外，我们的研究结果突出了GBS对死产的重大影响，揭示了低收入和中等收入国家一个此前被低估的方面。
