954. Trends in Group B Streptococcal Infections Among Infants <3 Months of Age and the Potential Impact of a Maternal Vaccine in the United States (2006-2014)
Session: Oral Abstract Session: Pediatric Epidemiology: Outbreaks and Surveillance
Friday, October 28, 2016: 10:30 AM
Room: 288-290
Background: Intrapartum antibiotic prophylaxis (IAP) recommendations for prevention of early-onset neonatal group B streptococcal (GBS) disease were first implemented in the 1990s. Despite declines in newborn disease following these and subsequent recommendations, GBS remains the leading cause of neonatal sepsis and meningitis in the United States. We analyzed GBS disease trends among young infants from 2006 through 2014 and estimated the potential impact of serotype-specific vaccines.

Methods: We defined early-onset disease (EOD) cases as GBS infections in infants aged 0-6 days and late-onset disease (LOD) as infections among infants aged 7-89 days. To calculate incidence, we used cases identified by Active Bacterial Core surveillance (ABCs), a surveillance system covering nearly 10% of US births, for numerators, and live births from state vital records for denominators. We used the Cochrane-Armitage test to analyze the significance of trends in annual incidence rates. We analyzed serotype data from 7 of 10 ABCs sites that collect GBS isolates. We used national estimates of GBS disease among infants and data from ABCs on serotype distribution in a model with assumptions about efficacy to estimate potential impact of a vaccine.

Results: During 2006-2014, ABCs identified 1,180 EOD and 1,246 LOD cases. Overall EOD incidence initially declined, from 0.38 (2006) to 0.27 (2010) cases per 1000 live births (P<.0001), but stabilized at ~0.26/1000 live births since 2011. LOD incidence has largely remained unchanged over the nine year period at ~0.30/1000 live births. Serotype data were available for 1564 (91.4%) of 1711 EOD and LOD cases from sites that collected GBS isolates. The five most common serotypes (Ia, Ib, II, III and V) caused 93% of EOD and 94% of LOD. Assuming an efficacy of 80%, we estimated that a vaccine against these serotypes could prevent around 600 cases of EOD and 580 cases of LOD each year nationally.

Conclusion: Despite use of IAP, perinatal GBS remains a concern. EOD rates have plateaued in recent years while LOD rates remain unchanged. A vaccine containing the five most common serotypes, if effective, offers an opportunity to further reduce EOD, and reduce LOD for which there is no public health intervention.

Srinivas Nanduri, MBBS, MD, MPH1, Susan Petit, MPH2, Joan Baumbach, MD, MPH, MS3, Arthur Reingold, MD, FIDSA4, Lisa Miller, MD, MSPH5, Lee Harrison, MD6, Ruth Lynfield, MD, FIDSA7, Shelley M. Zansky, PhD8, William Schaffner, MD, FIDSA, FSHEA9, Ann Thomas, MD, MPH10, Monica Farley, MD, FIDSA11, Stephanie Schrag, DPhil1 and Gayle E. Langley, MD, MPH1, (1)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Connecticut Department of Public Health, Hartford, CT, (3)New Mexico Department of Health, Santa Fe, NM, (4)University of California - Berkeley, Berkeley, CA, (5)Colorado Department of Public Health and Environment, Denver, CO, (6)University of Pittsburgh, Pittsburgh, PA, (7)Minnesota Department of Health, St. Paul, MN, (8)New York State Department of Health, Albany, NY, (9)Vanderbilt University School of Medicine, Nashville, TN, (10)Acute and Communicable Disease Prevention, Oregon Department of Human Services, Portland, OR, (11)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA

Disclosures:

S. Nanduri, None

S. Petit, None

J. Baumbach, None

A. Reingold, None

L. Miller, None

L. Harrison, None

R. Lynfield, None

S. M. Zansky, None

W. Schaffner, None

A. Thomas, None

M. Farley, None

S. Schrag, None

G. E. Langley, None

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