Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis

Pediatr Infect Dis J. 2008 Dec;27(12):1057-64. doi: 10.1097/INF.0b013e318180b3b9.


Background: Intrapartum antibiotic prophylaxis for neonatal group B streptococcal disease (GBS) effectively prevents disease among infants <7 days old, but there are no prevention strategies for late-onset GBS disease (onset on days 7-89 of life). We describe trends in late-onset GBS over a 16-year period to characterize disease burden and estimate vaccine preventability.

Methods: We conducted active, population-based surveillance for invasive late-onset GBS disease in 10 states from 1990 to 2005. A case was defined by GBS isolation from a normally sterile site on day 7-89 of life in a surveillance area resident. Incidence rates were calculated per 1000 resident live births.

Results: We identified 1726 cases; 26% presented with meningitis, and the case fatality ratio was 4.3%. Incidence was similar throughout the study period. Incidence among black infants was approximately 3 times that among non-black infants; the disparity persisted when data were stratified by gestational age. We estimate approximately 1300 cases of late-onset GBS occur annually in the United States. Birth at <37 weeks gestation was common among case-infants (49%) and was associated with elevated case fatality (relative risk: 3.8; 95% confidence interval: 1.1-13.2). Of 653 serotyped isolates, serotypes III (53%), IA (24%), and V (13%) predominated. During 2003-2005, 81 (36%) of the 227 cases caused by serotypes III, IA, and V were born before 34 weeks gestation.

Conclusions: The late-onset GBS disease burden remains substantial. A trivalent vaccine could be an effective prevention strategy. Because many cases were born preterm, reducing the opportunity for transplacental antibody transfer, adolescent immunization should be considered.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Confidence Intervals
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Infant, Newborn, Diseases / drug therapy
  • Infant, Newborn, Diseases / epidemiology*
  • Infant, Newborn, Diseases / prevention & control
  • Male
  • Neonatal Screening
  • Population Surveillance
  • Pregnancy
  • Risk Factors
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / prevention & control
  • Streptococcal Vaccines / administration & dosage*
  • Streptococcal Vaccines / therapeutic use
  • Streptococcus agalactiae / isolation & purification*
  • United States / epidemiology
  • Vaccination / statistics & numerical data


  • Streptococcal Vaccines