Elsevier

Vaccine

Volume 35, Issue 35, Part A, 16 August 2017, Pages 4457-4460
Vaccine

Prospects for preventing infant invasive GBS disease through maternal vaccination

https://doi.org/10.1016/j.vaccine.2017.02.025Get rights and content

Abstract

Group B streptococcus (GBS) is a leading cause of neonatal sepsis, with the highest incidence (1.3 per 1000 live births) reported from Africa. Although the incidence of invasive GBS disease is reportedly low in South Asia, there is disconnect between prevalence of maternal recto-vaginal colonization and the incidence of early-onset disease (EOD). This is possibly due to case-ascertainment biases that omit investigation of newborns dying on day-0 of life, which accounts for >90% of EOD. Furthermore, GBS is associated with approximately 15% of all infection related stillbirths. Vaccination of pregnant women with a serotype-specific polysaccharide epitope vaccine could possibly protect against EOD and late-onset disease (LOD) in their infants through transplacental transfer of serotype-specific capsular antibody. Furthermore, vaccination of pregnant women might also protect against impaired neurodevelopment following GBS associated neonatal sepsis, and fetal loss/stillbirths. Licensure of a GBS vaccine might be feasible based on safety evaluation and a sero-correlate of protection, with vaccine effectiveness subsequently being demonstrated in phase IV studies. A randomized-controlled trial would, however, be best suited as a vaccine-probe to fully characterize the contribution of GBS to neonatal sepsis associated morbidity and mortality and adverse fetal outcomes.

Section snippets

Preventing invasive GBS disease through maternal vaccination

The earliest evidence suggestive that maternal GBS vaccination might prevent invasive GBS disease in their infants was premised on studies by Carol Baker in the 1970s, which showed higher maternal serotype-specific capsular antibody levels being associated with lower risk for developing invasive GBS disease in neonates born to mothers colonized with the homotypic serotypes[21]. Further studies by others including more recently from Africa, corroborated these findings, although the differences

Competing interests

None.

Financial disclosure/support

SAM is funded in part by National Research Foundation/Department of Science and Technology: South African Research Chair Initiative Program and Medical Research Council of South Africa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

References (49)

  • G. Kwatra et al.

    Natural acquired humoral immunity against serotype-specific group B Streptococcus rectovaginal colonization acquisition in pregnant women

    Clin Microbiol Infect

    (2015)
  • P.S. Pannaraj et al.

    Alpha C protein-specific immunity in humans with group B streptococcal colonization and invasive disease

    Vaccine

    (2008)
  • S.A. Madhi et al.

    Considerations for a phase-III trial to evaluate a group B Streptococcus polysaccharide-protein conjugate vaccine in pregnant women for the prevention of early- and late-onset invasive disease in young-infants

    Vaccine

    (2013)
  • R. Borrow et al.

    Meningococcal surrogates of protection–serum bactericidal antibody activity

    Vaccine

    (2005)
  • L. Jodar et al.

    Serological criteria for evaluation and licensure of new pneumococcal conjugate vaccine formulations for use in infants

    Vaccine

    (2003)
  • D.R. Feikin et al.

    Use of vaccines as probes to define disease burden

    Lancet

    (2014)
  • Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

    Lancet

    (2016)
  • P.T. Heath et al.

    Group B streptococcal disease in infants: a case control study

    Arch Dis Child

    (2009)
  • Z. Dangor et al.

    Burden of invasive group B Streptococcus disease and early neurological sequelae in South African infants

    PLoS ONE

    (2015)
  • C.R. Phares et al.

    Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005

    JAMA

    (2008)
  • U. Allen et al.

    Relationship between antenatal group B streptococcal vaginal colonization and premature labour

    Paediatr Child Health

    (1999)
  • S.E. Bakhuizen et al.

    Meta-analysis shows that infants who have suffered neonatal sepsis face an increased risk of mortality and severe complications

    Acta Paediatr

    (2014)
  • J.R. Verani et al.

    Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010

    MMWR Recomm Rep

    (2010)
  • C.L. Cutland et al.

    Maternal HIV infection and vertical transmission of pathogenic bacteria

    Pediatrics

    (2012)
  • View full text