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Maternal Colonization and Neonatal Group B Streptococcal Infection: Time to Universal Screening and Intrapartum Chemoprophylaxis in Taiwan?
Pediatrics and Neonatology (2011) 52, 181e182
available at www.sciencedirect.com
journal homepage: http://www.pediatr-neonatol.com
EDITORIAL
Maternal Colonization and Neonatal Group B Streptococcal Infection: Time to Universal Screening and Intrapartum Chemoprophylaxis in Taiwan? Group B streptococcal (GBS) disease is an important and potentially life-threatening disease in newborns. Since 1970s, extensive research has provided important information on epidemiology, immunity, and prevention, resulting in a decline in incidence and mortality rates. GBS colonize the vaginal and gastrointestinal tracts in healthy women, with carriage rates ranging from 6.5% to 43.6% in the United States and other countries.1,2 Neonates can acquire the organism vertically in utero or during delivery from the maternal genital tract. Although the transmission rate from mothers colonized with GBS to neonates delivered vaginally ranged from 40% to 70% (approximately 50%),3 only 1e2% of colonized neonates go on to develop invasive GBS disease.4 However, Taiwan has very limited data on the epidemiological characteristics of maternal GBS colonization and neonatal GBS diseases. In this issue of Pediatrics and Neonatology, Yu et al5 reported that the maternal colonization of GBS was around 20% in Taiwan through a prospective study in six hospitals and that the neonatal GBS infection was 1 per 1000 live births. If transmission rate from mothers colonized with GBS to neonates is approximately 50%, the colonization rate of newborns would be around 10%, and about 1% of colonized neonates go on to have neonatal GBS infection in Taiwan. The figure is similar to that of Western countries before intrapartum chemoprophylaxis. The incidence of early-onset GBS infection had dropped by 50e85% in the United States6 since the implementation of intrapartum antibiotic prophylaxis in 1996.7 As all of us know, the crude birth rate in Taiwan decreased to 8 per 1000 in 2009, the second lowest in the world. Taiwan’s infant mortality rate was 4.1 per 1000 live births in 2009,8 which was acceptable but much higher than the lowest in the world (1.8 per 1000 live births in both Hong Kong and
Luxembourg) and the second lowest (2.1 per 1000 live births in Singapore).9 Because Taiwan’s birth rate is decreasing, we have to try our best to decrease the newborn and infant mortality rate. To achieve this, decreasing newborn GBS infection is one of the strategies. At present, there is no standard protocol for GBS screening of the pregnant women in Taiwan. No universal screening of maternal GBS will make intrapartum chemoprophylaxis incomplete although we know many of the hospitals in Taiwan do the maternal GBS screening. If we would like to decrease newborn GBS infection in Taiwan, it is necessary to perform universal screening of pregnant women for rectovaginal GBS colonization at 35e37 weeks’ gestation to optimize the identification of women who should receive intrapartum antibiotic prophylaxis. Universal screening of maternal GBS will make clear the nationwide GBS colonization rate of pregnant women in Taiwan, will let obstetrician give appropriate intrapartum chemoprophylaxis, and will let pediatricians know which newborn needs special observation or treatment for GBS diseases to reduce the incidence, morbidity, and mortality of neonate GBS diseases. We hope that the health authority in Taiwan will set up its strategy to decrease the incidence of early-onset neonatal GBS disease in the near future. Luan-Yin Chang Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail addresses: [email protected], [email protected]
1875-9572/$36 Copyright ª 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved. doi:10.1016/j.pedneo.2011.05.001
182
References 1. Yu ¨cesoy G, Calis‚kan E, Karadenizli A, et al. Maternal colonisation with group B streptococcus and effectiveness of a culturebased protocol to prevent early-onset neonatal sepsis. Int J Clin Pract 2004;58:735e9. 2. Gavino M, Wang E. A comparison of a new rapid real-time polymerase chain reaction system to traditional culture in determining group B streptococcus colonization. Am J Obstet Gynecol 2007;197:388e1e4. 3. Yancey MK, Duff P, Clark P, et al. Peripartum infection associated with vaginal group B streptococcal colonization. Obstet Gynecol 1994;84:816e9. 4. Agnoli FL. Group B streptococcus: perinatal consideration. J Fam Pract 1994;39:171e7.
Editorial 5. Yu HW, Lin HC, Yang PH, et al. Group B streptococcal infection in Taiwan: maternal colonization and neonatal infection. Pediatr Neonatol 2011;52:190e5. 6. Centers for Disease Control. Perinatal group B streptococcal disease after universal screening recommendationsdUnited States, 2003e2005. MMWR 2007;56:701e5. 7. Centers for Disease Control. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Morb Mortal Wkly Rep 1996;45:1e24. 8. Department of Statistics, Ministry of the Interior, Taiwan. Statistics: weekly report of Ministry of the Interior. Available from: http://sowf.moi.gov.tw/stat/week/list.htm [accessed 05.01.11]. 9. Department of Statistics, Ministry of the Interior, Taiwan. International index: the infant mortality rate. Available from: http:// sowf.moi.gov.tw/stat/national/j028.xls [accessed 05.01.11].
available at www.sciencedirect.com
journal homepage: http://www.pediatr-neonatol.com
EDITORIAL
Maternal Colonization and Neonatal Group B Streptococcal Infection: Time to Universal Screening and Intrapartum Chemoprophylaxis in Taiwan? Group B streptococcal (GBS) disease is an important and potentially life-threatening disease in newborns. Since 1970s, extensive research has provided important information on epidemiology, immunity, and prevention, resulting in a decline in incidence and mortality rates. GBS colonize the vaginal and gastrointestinal tracts in healthy women, with carriage rates ranging from 6.5% to 43.6% in the United States and other countries.1,2 Neonates can acquire the organism vertically in utero or during delivery from the maternal genital tract. Although the transmission rate from mothers colonized with GBS to neonates delivered vaginally ranged from 40% to 70% (approximately 50%),3 only 1e2% of colonized neonates go on to develop invasive GBS disease.4 However, Taiwan has very limited data on the epidemiological characteristics of maternal GBS colonization and neonatal GBS diseases. In this issue of Pediatrics and Neonatology, Yu et al5 reported that the maternal colonization of GBS was around 20% in Taiwan through a prospective study in six hospitals and that the neonatal GBS infection was 1 per 1000 live births. If transmission rate from mothers colonized with GBS to neonates is approximately 50%, the colonization rate of newborns would be around 10%, and about 1% of colonized neonates go on to have neonatal GBS infection in Taiwan. The figure is similar to that of Western countries before intrapartum chemoprophylaxis. The incidence of early-onset GBS infection had dropped by 50e85% in the United States6 since the implementation of intrapartum antibiotic prophylaxis in 1996.7 As all of us know, the crude birth rate in Taiwan decreased to 8 per 1000 in 2009, the second lowest in the world. Taiwan’s infant mortality rate was 4.1 per 1000 live births in 2009,8 which was acceptable but much higher than the lowest in the world (1.8 per 1000 live births in both Hong Kong and
Luxembourg) and the second lowest (2.1 per 1000 live births in Singapore).9 Because Taiwan’s birth rate is decreasing, we have to try our best to decrease the newborn and infant mortality rate. To achieve this, decreasing newborn GBS infection is one of the strategies. At present, there is no standard protocol for GBS screening of the pregnant women in Taiwan. No universal screening of maternal GBS will make intrapartum chemoprophylaxis incomplete although we know many of the hospitals in Taiwan do the maternal GBS screening. If we would like to decrease newborn GBS infection in Taiwan, it is necessary to perform universal screening of pregnant women for rectovaginal GBS colonization at 35e37 weeks’ gestation to optimize the identification of women who should receive intrapartum antibiotic prophylaxis. Universal screening of maternal GBS will make clear the nationwide GBS colonization rate of pregnant women in Taiwan, will let obstetrician give appropriate intrapartum chemoprophylaxis, and will let pediatricians know which newborn needs special observation or treatment for GBS diseases to reduce the incidence, morbidity, and mortality of neonate GBS diseases. We hope that the health authority in Taiwan will set up its strategy to decrease the incidence of early-onset neonatal GBS disease in the near future. Luan-Yin Chang Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail addresses: [email protected], [email protected]
1875-9572/$36 Copyright ª 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved. doi:10.1016/j.pedneo.2011.05.001
182
References 1. Yu ¨cesoy G, Calis‚kan E, Karadenizli A, et al. Maternal colonisation with group B streptococcus and effectiveness of a culturebased protocol to prevent early-onset neonatal sepsis. Int J Clin Pract 2004;58:735e9. 2. Gavino M, Wang E. A comparison of a new rapid real-time polymerase chain reaction system to traditional culture in determining group B streptococcus colonization. Am J Obstet Gynecol 2007;197:388e1e4. 3. Yancey MK, Duff P, Clark P, et al. Peripartum infection associated with vaginal group B streptococcal colonization. Obstet Gynecol 1994;84:816e9. 4. Agnoli FL. Group B streptococcus: perinatal consideration. J Fam Pract 1994;39:171e7.
Editorial 5. Yu HW, Lin HC, Yang PH, et al. Group B streptococcal infection in Taiwan: maternal colonization and neonatal infection. Pediatr Neonatol 2011;52:190e5. 6. Centers for Disease Control. Perinatal group B streptococcal disease after universal screening recommendationsdUnited States, 2003e2005. MMWR 2007;56:701e5. 7. Centers for Disease Control. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Morb Mortal Wkly Rep 1996;45:1e24. 8. Department of Statistics, Ministry of the Interior, Taiwan. Statistics: weekly report of Ministry of the Interior. Available from: http://sowf.moi.gov.tw/stat/week/list.htm [accessed 05.01.11]. 9. Department of Statistics, Ministry of the Interior, Taiwan. International index: the infant mortality rate. Available from: http:// sowf.moi.gov.tw/stat/national/j028.xls [accessed 05.01.11].