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American obstetricians have noted a significant decline in Group B Strep infection in newborn babies as a result of their universal screening programme. Is it time for a similar system in the UK?
By Ali Cloak
A recent American article has summarised the key advances in testing pregnant women for Group B Streptococcus infection in the United States and sets out how the scheme has reduced instances of potentially fatal GBS infection in newborn babies. This blog focuses on the approach adopted in the US and compares it with the system currently in place in the UK, where incidences of GBS infection are reported to be increasing.
A recent article published by Contemporary Ob/Gyn , outlines the history of GBS testing and guidelines in the USA and, in doing so, shows a marked reduction in the instances of GBS infection in newborn babies. This is particularly pertinent as July 2013 is Group B Strep awareness month in the UK, a campaign led by the charity GBS Support.
Group B Streptococcus infection (also known as ‘Strep B’ or ‘GBS’) is a type of bacteria which is commonly carried by both men and women. Generally, carriers are not affected by the bacteria. However, if a pregnant woman is carrying GBS then it can be transmitted to the baby during labour and, if left untreated, it can cause serious mental or physical disability or even death.
If it is known that the mother is carrying GBS during the late stages of her pregnancy then a very short course of IV antibiotics can be offered to prevent transmission to the newborn. If it is too late for a successful course to be administered to the mother then antibiotics can be given directly to the baby. Knowing that the mother is carrying GBS is key to successful prevention of GBS infection in the newborn baby.
GBS was first investigated in the 1930s, as part of wider research to investigate maternal sepsis (blood poisoning). It wasn’t until 30 years later than the link between maternal GBS and neonatal GBS infection was recognised.
In 1994 a protocol was adopted for screening to be offered in certain circumstances and IV antibiotic treatment was to be offered to those mothers known to be carrying GBS and those evidencing certain risk factors such as pyrexia (high temperature). The test itself is simple and is done by way of swab.
The guidance was subsequently reviewed in 2002 and the American Centres for Disease Control and Prevention (CDC) recommended that antepartum screening be universal in women between 35-37 weeks’ pregnant.
Thankfully there are now far fewer incidences of GBS infection in newborn babies in the US. There have been improvements in the standard of the GBS testing methods themselves which has made diagnosing and treating GBS infection more accurate. There are also fewer deaths in those babies who do acquire the infection, because of the advances in paediatric medicine and increased awareness of the infection and its affects amongst treating staff.
In the 1970s early GBS infection was thought to be as high as 2 per 1000 live births in the US (1 in 500 births). By 2008 this had reduced to as few as 0.3 per 1000 live births (1 in over 3000 births).
The reduction in GBS infection in babies in the United States can be mostly attributed to the universal screening programme on offer. A similar system has been adopted in many European countries. As a result of universal screening programmes the number of GBS infections in newborn babies has fallen significantly in Spain, Australia and France. In the UK, currently only those women who are known to have previously carried GBS or those with specific risk factors are offered screening/treatment. Routine screening for GBS is not offered and the incidence of infection is increasing.
GBS Support is campaigning for a more wide-ranging screening programme to be adopted in the UK. GBS Support believes all women should be offered the opportunity to have a sensitive test to detect GBS carriage late in pregnancy. Presence of the bacteria can be confirmed with a simple swab test and prompt, simple treatment can then be offered if necessary.
As clinical negligence solicitors we see the devastating effects of this infection on babies and their families and therefore fully support this campaign to reduce the incidence of this infection. GBS Screening: An update on guidelines and methods; Haywood L. Brown, MD and Homa K. Ahmadzia, MD, MPH and R. Phillips Heine, MD; 01.07.2013