the burden of invasive group b streptococcal (gbs) disease...
TRANSCRIPT
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The burden of invasive Group B Streptococcal
(GBS) disease in young infants in the UK &
Republic of IrelandDr Catherine O’Sullivan, Research Fellow to Professor Paul
Heath, Paediatric Infectious Diseases at St George’s,
University of London
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The burden of invasive GBS in young infants in the UK & ROI
2014 -2015
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Surveillance
• To define the current burden of GBS in UK & Irish infants less than 90 days of age and to identify the current disease-causing serotypes.
• Case definition:– Sterile site
– Infant <90 days
• Sources:– Paediatricians / neonatologists (BPSU)
– Isolates
– Laboratory notifications
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British PaediatricSurveillance Unit
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CASES
597 CLINICIAN CASES
+
220 MICRO CASES
=
817 CASES
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Country
England655 (80.2%)
Scotland54 (6.6%)
Wales24 (2.9%)
NI28 (3.4%)
ROI56 (6.9%)
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Onset
Early&onset&59.97%
Late&onset&40.03%
Onset&of&disease2000-2001:LO 33.6%EO 66.3%
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Incidenceper 1,000 LBs
Total cases (n)
Total incidence2014-2015
2000-2001 incidence
Earlyonsetcases (n)
Early onset incidence2014-2015
2000-2001 incidence
Late onsetcases (n)
Late onset incidence2014-2015
2000-2001 incidence
Incidence per 1,000LBs
817 0.89 0.72 475 0.52 0.48 317 0.35 0.24
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Incidenceper 1,000 LBs
Country Total cases (n)
Total incidence2014-2015
2000-2001 incidence
Early onset incidence2014-2015
2000-2001 incidence
Late onset incidence2014-2015
2000-2001 incidence
England 655 0.91 0.75 0.56 0.5 0.36 0.25
Scotland 54 0.88 0.42 0.24 0.21 0.28 0.21
Wales 24 0.66 0.59 0.33 0.35 0.33 0.24
NI 28 1.06 0.9 0.64 0.73 0.34 0.17
ROI 56 0.77 0.6 0.44 0.34 0.31 0.26
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Birth weight
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IncidenceEngland
BWper 1,000 LBs
BW Total cases (n)
Total incidence2014-2015
Early onset incidence2014-2015
Late onset incidence2014-2015
VLBW (≤1500g) 52 6.87 1.32 5.55
LBW (<2500g) 70 1.65 0.99 0.66
≥2500g 313 0.48 0.35 0.13
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Day of onset
0100
200
300
Number+of+cases
0 20 40 60 80 100Day+of+life
Day+of+onset
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0100
200
300
Number+of+cases
1 2 3 4 5 6Early+onset+DOL
05
10
15
Number+of+cases
0 20 40 60 80 100Late+onset+DOL
Day+of+onset
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Clinical DxEOD
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Clinical DxLOD
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Mortality
EO#Deaths#(15)
LO#Deaths#(22)
EOD LOD
Deaths
Overall mortality2014-2015
Overall mortality 2000-2001
Early onset mortality2014-2015
Early onset mortality 2000-2001
Late onsetmortality2014-2015
Late onset mortality 2000-2001
6.2% (n=37)
9.7%(n=53)
4.3% (n=15)
10.6%(n=38)
8.9%(n=22)
8%(n=15)
Median time after infection: 3 days 76% within 7 days of infection22% within 28 days of infection
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MortalityGestation & BW
Mortality≤33/402014-2015
Mortality ≤33/40 2000-2001
Mortality 34-36/402014-2015
Mortality 34-36/402000-2001
Mortality ≥37/402014-2015
Mortality ≥37/402000-2001
12.2%(n=12)
15.2% (n=19)
4.2% (n=3)
13.2%(n=12)
4.4%(n=18)
6.4%(n=21)
Mortality <1000g(ELBW)
Mortality <1500g (VLBW)
Mortality <2500g (LBW)
Mortality >2500g
17.1% (n=6) 13.3% (n=4) 6% (n=5) 4.5% (n=18)
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Serotypes
020
40
60
80
100
Number-of-cases
Ia Ib II III IV V VI VII VIII NTSerotypes
Early-onset-disease
Serotypes
050
100
150
Number*of*cases
Ia Ib II III IV V VI NTSerotypes
Late*onset*disease
Serotypes
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SerotypesMeningitis
010
20
30
40
Number,of,cases
Ia Ib II III IV V VI NT 9 10Serotypes
Late,onset,meningi>s
Serotypes
05
10
15
20
25
Number+of+cases
Ia Ib II III IV V VI VII VIII NTSerotypes
Early+onset+meningi=s
Serotypes
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Demographics
Female&46%
Male&54%
Female Male
Gender
010
020
030
040
0Num
ber,of,cases
White
White/Black,Caribbean
White/Black,Asian
White/Asian
Other,M
ixed
Indian
Pakistani
Bangladeshi
Other,Asian
Caribbean
African
Other,African
Chinese
Any,Other
Ethnicity
Ethnicity available for 63.4% of cases (n=518)White 74.9%Pakistani 3%African 2.9%
38 twins
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Risk factorsEOD
• RCOG Green top Guidance recommends IAP to those:
• Found to be colonised
• GBS bacteriuria/UTI
• Suspected chorioamnionitis
• Maternal pyrexia (T>38oC)
• Previous baby with GBS
Preterm delivery < 37/402014-2015
Preterm delivery< 37/40
2000-2001
PROM >18hrs2014-2015
PROM >18hrs2000-2001
Knowncarriage2014-2015
Knowncarriage2000-2001
Maternal pyrexiaand/or suspected chorioamnionitis
21%(n=75)
37%(n=131)
5.4%(n=19)
44%(n=140)
10.8%(n=38)
4%(n=13)
29%(n=102)
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Antibiotics given during labour
02
46
810
Number-of-cases
Benzylpenicillin
Cefuroxim
e/Metronidazole
Co@Amoxiclav
Cefuroxim
eClindamycin
Benpen/Gentamicin/Metronidazole
Amoxicillin/Metronidazole
Co@Amoxiclav/Benpen
Benpen/Metronidazole
Gentamicin
Gentamicin/Metronidazole
AnDbioDcs
AnDbioDcs-given-in-labour
Median time given: 2 hours pre-delivery
2-4hrs: 30%> 4hrs: 13%
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LOD
• NICU inpatient: 21%
• Relapses:
– 1.68% (n=10)
• Outcomes:
– 1 died
– 1 major disability
– 8 healthy at discharge
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Meningitis
• CSF culture: 69% • Clinical/LP results consistent: 31%
• EOD 55%• LOD 90%
• Lumbar puncture:• Yes 84%, Unknown 2.5%, No 13.4%• NO:
– Too sick 31– Unsuccessful attempt 22– Parents refused 1– No reason given 26
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Outcome
Died
Healthy
Major/Disability
Minor/Disability Uncertain
Unknown
Outcome/at/discharge
Died
Healthy
Major/disability/
Minor/disability
Uncertain
Unknown
Meningi8s
Outcome/at/discharge
78% healthy at discharge 66% healthy at discharge
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Summary
• 2014-2015 Incidence in young infants: – 0.89 per 1,000 LBs
• Changes since 2000-2001 surveillance:– Increased incidence across countries– Greater increase in LOD incidence– Lower overall mortality & EOD mortality– Higher LOD mortality
• Serotype distribution – vaccine coverage– Ia, Ib, II, III, V: 94%– Trivalent: Ia, Ib, III: 82%– Ia, Ib, II, III: 87.6%
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Acknowledgements
• Professor Paul Heath• Dr Theresa Lamagni• Dr Androulla Efstratiou
• Dr Tatiana Munera Huertes• Dr Shamez Ladhani• Dr Christine Jones• Maxine Ng
• Dr Darshana Patel • Nick Hinton • Shahzad Shakeb
• Dr Richard Lynn• Jacob Avis
• Dr Robert Cunney• Dr Mary Meehan
• Dr Arlene Reynolds• Diogo Marques
• Dr Margaret Boyle• Dr Lorraine Doherty• Ruth Campbell
• Dr Eleri Davies
• All paediatricians and microbiologists who have contributed