Program Schedule

Obesity, Diabetes, and the Risk of Invasive Group B Streptococcal Disease in Non-Pregnant Adults

Session: Oral Abstract Session: Epidemiology and Prevention of Infectious Diseases
Saturday, October 11, 2014: 10:30 AM
Room: The Pennsylvania Convention Center: 111-AB

The incidence of invasive group B streptococcus disease (GBS) in adults in the United States is increasing. We hypothesized that both obesity and diabetes are independently associated with an increased risk of invasive GBS infection. 


Population-based surveillance for invasive GBS disease in adults ≥ 18 was conducted at 9 Active Bacterial Core surveillance (ABCs) sites from January 1, 2010 – December 31, 2011.  Invasive GBS disease was defined as isolation of GBS from a normally sterile site (e.g., blood) in an ABCs site resident. Demographic and clinical data, including medical conditions, height, weight, and body mass index (BMI), were abstracted from the medical record.  We imputed missing data using the multiple imputation by chained equations algorithm (BMI imputed in 21% of cases).  We estimated the denominator for the surveillance area population using weighted frequencies from the Behavioral Risk Factor Surveillance System from 2010 and adjusted for self-report bias by sex and 5-year age categories using data from the National Health and Nutrition Evaluation Survey.  Rates and rate ratios (RR) were estimated using Poisson regression with offset denominators.   


We identified 3135 eligible cases of invasive GBS infection.  From models adjusted for age, sex, race, and diabetes, the relative risks (RR (95% CI)) for invasive GBS for BMI (kg/m2) ≥40 (morbid obesity), BMI 30-<40, and BMI 25-<30 were 3.1 (2.2 – 4.5), 1.0 (0.7 – 1.4), and 0.7 (0.5-0.9), respectively, compared to 18.5-<25 (normal).  The RR for diabetes was 6.2 (4.8 – 7.8).   Stratified analyses showed that morbid obesity was less predictive of GBS among those with diabetes.


Morbid obesity and diabetes were associated with a substantially increased risk of invasive GBS infection with a smaller effect of morbid obesity among diabetics. These data suggest that efforts to prevent obesity and diabetes might reduce the incidence of adult invasive GBS infection in the U.S.

Samantha Pitts, MD, MPH1, Nisa Maruthur, MD, MHS1, Gayle E. Langley, MD, MPH2, Tracy Pondo, MSPH2, Kathleen Shutt, MS3, Rosemary Hollick, MS4, Stephanie Schrag, DPhil5, Ann Thomas, MD, MPH6, Megin Nichols, DVM, MPH, DACVPM7, Monica Farley, MD8, James Watt, MD, MPH9, Lisa Miller, MD, MSPH10, William Schaffner, MD11, Corinne Holtzman, MPH12 and Lee Harrison, MD13, (1)Medicine, Johns Hopkins University, Baltimore, MD, (2)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (3)Medicine, University of Pittsburgh Division of Infectious Diseases, Pittsburgh, PA, (4)International Health, Johns Hopkins University School of Public Health, Baltimore, MD, (5)Centers for Disease Control and Prevention, Atlanta, GA, (6)Emerging Infections Program, Portland, OR, (7)New Mexico Department of Public Health, Santa Fe, NM, (8)Emory Univ. & VAMC, Decatur, GA, (9)Center for Infectious Diseases, California Department of Public Health, Sacramento, CA, (10)Colorado Department of Public Health and Environment, Denver, CO, (11)Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, (12)Minnesota Department of Health, St. Paul, MN, (13)Infectious Diseases, University of Pittsburgh, Pittsburgh, PA


S. Pitts, None

N. Maruthur, None

G. E. Langley, None

T. Pondo, None

K. Shutt, None

R. Hollick, None

S. Schrag, None

A. Thomas, None

M. Nichols, None

M. Farley, None

J. Watt, None

L. Miller, None

W. Schaffner, None

C. Holtzman, None

L. Harrison, None

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