Revisiting the Need for Vaccine Prevention of Late-Onset Neonatal Group B Streptococcal Disease A Multistate, Population-Based Analysis

Background: intrapartum antibiotic prophylaxis for neonatal group B streptococcal disease (GBS) effectively prevents disease among infants < 7 clays old, but there are no prevention strategies for late-onset GBS disease (Onset on days 7-89 of life). We describe trends in late-onset GBS over 16-year period to characterize disease burden and estimate vaccine preventability. Methods: We conducted active, population-based surveillance for invasive late-onset GBS disease in 10 states Front 1990 to 2005. A case was defined by GBS isolation front a normally sterile site oil day 7-89 of life in a surveillance area resident. Incidence rates were calculated per 1000 resident live births. Results: We identified 1726 cases; 26% presented with meningitis, and the ease fatality ratio was 4.3%. Incidence was similar throughout the study period. Incidence among black infants was approximately 3 times that among nonblack infants; the disparity persisted when data were stratified by gestational age. We estimate approximately 1300 cases of late-onset GBS occur annually in the United States. Birth at < 37 weeks gestation was common among case-infants (49%) and was associated with elevated case fatality (relative risk: 3.8; 95% confidence interval: 1.1-13.2). Of 653 serotyped isolates, serotypes III (53%), IA (24%), and V (13%) predominated. During 2003-2005, 81 (36%) of the 227 cases caused by serotypes III, IA, and V were born before 34 weeks gestation. Conclusions: The late-onset GBS disease burden remains substantial A trivalent vaccine Could be an effective prevention strategy. Because many cases were born preterm, reducing the opportunity for transplacental antibody transfer, adolescent immunization should be considered.