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Although group B streptococcus (GBS) is commonly thought of as a cause of disease in neonates and pregnant women, it causes substantial morbidity and mortality among nonpregnant adults, and appears to be increasing in incidence in that population. The epidemiology of GBS endocarditis has undergone a shift since the preantibiotic era. Previously, endocarditis was one of the most common syndromes caused by GBS infection, but GBS endocarditis is much rarer today. Many pregnant women are colonized with GBS but are asymptomatic. However, GBS colonization in pregnant women is important because of the risk for transmission to their newborns. Infections in newborns commonly present as bacteremia, meningitis, or pneumonia. There are two distinct syndromes: early-onset disease (EOD), which appears in the first week of life, usually within the first 24 h, and late-onset disease (LOD), which occurs on or after 7 days of age. Risk factors for late-onset GBS disease have recently been characterized, though they are less well understood than those for EOD. A recent hospital matched case-control study of risk factors for LOD conducted in Houston identified prematurity as the major risk factor for late-onset GBS disease, with maternal GBS colonization and black race as other independent factors associated with higher risk of LOD. Development of a vaccine against GBS may provide a better long-term solution than chemoprophylaxis. A vaccine could be given to women during pregnancy or to adolescent girls; transfer of antibodies across the placenta late in pregnancy would confer protection to the newborn.
Incidence of early-onset group B streptococcal disease (cases per 1,000 live births), 1989–2003 (Active Bacterial Core surveillance) (from reference 28 ) compared with Healthy People 2010 goal of 0.5 per 1,000 live births.
Algorithm for prevention of perinatal group B streptococcal disease, 2002 guidelines (from reference 27 ).
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