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Incidence of Group Strep B infection increasing, yet still no routine NHS screening

The issue of whether expectant mothers should be routinely screened for Group Strep B infection (GBS) has been raised in public awareness again recently due to reports of a 50% rise in the number of babies contracting the disease. The NHS still maintains its stance that there is no justification for a routine screening programme, despite the often devastating injuries and fatalities it causes. Surely things need to change?

RECENT REPORT

The BBC Radio 4 Today programme heard (in August 2013) from its reporter Nicola Stanbridge that researchers at Public Health England have found a 50% increase in the incidence of Group B streptococcus disease in babies, based on figures between 2005 and 2010 [1]. They also noted that Group B Strep infection is the most common cause of death recorded on death certificates of newborn babies. The BBC reported that 5-10% of babies who contract the disease will die, whilst of those who survive some can be severely brain damaged resulting in cerebral palsy.

As part of a Today programme interview Dr Nicholas Embleton, a neonatologist at Newcastle Hospitals NHS Trust, did not support the overall views of the charity Group B Strep Support that routine screening and treatment of women carrying the disease should be offered. He stated: “The problem is that you’re going to identify some 300-1000 people who could be struck at some point during the pregnancy, which means exposing an awful lot of women to antibiotics….The danger of that is you may risk allergic reactions in the mother, developing bacteria that are resistant to the type of antibiotics that are around, and if the baby becomes unwell with those germs that may be equally serious as group B Strep.”

The programme was criticised by the charity Group B Strep Support in a press release as they stated the “Director of the UK National Screening Committee, Dr Anne Mackie, made a misleading statement regarding the number of group B Strep infections.”  Dr Mackie had stated that only 40 babies in the UK were badly affected in 2010, when the correct figure was 302 babies.

THE NEED FOR ROUTINE SCREENING

In the Journal ‘The Practising Midwife’ for July/August 2013 [2] Jane Plumb and Ginny Clayton presented a paper for the benefit of midwives in preventing GBS infection in newborns. Their paper summarised a need for:

  • Women to be informed of GBS as part of routine antenatal care
  • For women to be routinely tested for GBS at 35-37 weeks in their pregnancy
  • For women who are colonised or infected with GBS or with particular risk factors to be offered prophylactic antibiotic treatment during labour.

They called for midwives to bear in mind these factors and also to take particular note of the symptoms of GBS infection in the neonate so that urgent medical attention can be sought if required.

They cited a UK study of Vergnano et al in 2010 [3]. The study reported that ‘67% of babies with early onset GBS infection were born to mothers with one or more GBS risk factors but only 21% of women received correct [antibiotic therapy]’. Sadly it concluded that 50-80% of the infections would have been prevented if existing guidelines had been followed.

SUMMARY

It is well know by NHS maternal care providers that GBS is the most common neonatal infection and the fact that it is easily prevented with appropriate screening and treatment, yet NICE Guidelines continue to maintain no justification for the steps encouraged by many campaigners.  It’s hard to imagine the suffering of parents who lose a child or watch their child suffer from a debilitating injury, particularly if that harm could have been easily avoided with the use of inexpensive antibiotics.

The clinical negligence team fully supports the campaign for increased awareness and testing of this awful disease.

[1] Emerging Trends in the Epidemiology of Invasive Group B Streptococcal Disease in England and Wales, 1991-2010. Theresa L. Lamagni et al. Clinical Infectious Diseases 2013; doi 10.1093/cid/cit337

[2] Pract Midwife. 2013 Jul-Aug;16(7):27-30

[3] ‘Missed opportunities for preventing group B streptococcus infection’ Arch Dis Child Fet Neo Ed, 95 (1):F72-F73

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