Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)
Authors: 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 ,   for the CHAMPS Consortium, Adam Yasmin , Agaya Janet , Ajanovic Sara , Alemu Addisu , Ali Solomon , Aol George , Badji Henry , Bari Sanwarul , Bramugy Justina , Bunn James , Chawana Richard , Chowdhury Atique Iqbal , Fairchild Karen D , Fentaw Surafel , Flora Meerjady Sabrina , Gethi Dickson , Govender Nelesh P , Greene Carol L , Gure Tadesse , Hale Martin , Hurtado Juan Carlos , Igunza Kitiezo Aggrey , Islam Farzana , Johnson J Kristie , Keita Tatiana , Khagayi Sammy , Khan Iqbal Ansary , Koka Rima , Kone Diakaridia , Kourouma Nana , Kuria Magdalene N , Lako Sandra , Lala Sanjay G , Lombaard Hennie , Luke Ronita , Misore Thomas , Mitei Paul K , Ibrahim Alexander M , Moultrie Andrew , Murila Florence V , Myburgh Nellie , Nyamthimba Peter , Oliech Richard , Omore Richard , Onwuchekwa Uma U , Orlien Stian M S , Othieno Louis , Otieno Peter , Otieno Kephas , Ouma Gregory , Owuor Benard , Parveen Shahana , Petersen Karen L , Rahman Mahbubur , Rakislova Natalia , Rogena Emily A , Sanogo Doh , Shirin Tahmina , Sidibe Diakaridia , Sissoko Seydou , Solomon Fatima , Sorour Gillian , Squire James Sylvester , Swart Peter J , Temesgen Fikremelekot , Tennant Sharon M , Thwala Bukiwe Nana , Traore Cheick Bougadari , Velaphi Sithembiso , Vitorino Pio , Wadula Jeannette , Yeshi Melisachew Mulatu 
Published: July 2023

Abstract

Background
Invasive Group B Streptococcus (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).

Methods
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.

Results
We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to &lt;24 hours, n = 597), early neonatal deaths (END) (1 day to &lt;7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus 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 &lt;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 &lt;2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths &lt;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).

Conclusions
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.