July is Group B Strep Awareness Month, a global initiative led Jane Plumb MBE, Chief Executive for UK charity Group B Strep Support (GBSS).
So what is 'group B Strep'? Well, otherwise known as, group B Streptococcus, it is a bacterium that lives in the intestines, rectum and/or vagina of about 20-40% of women in the UK. Carrying this bacteria doesn’t cause any symptoms or problems, and most women won’t know they are carrying it. It usually only causes problems after a baby is exposed to group B Strep around labour and in the early weeks after birth.
However, when group B Strep does cause a problem, it can be very serious. Group B Strep is the most common cause of severe infection in newborn babies, typically developing in their first week of life (early-onset GBS infection), and less frequently up to age three months (late-onset GBS infection).
Group B Strep infections in babies typically present as sepsis, meningitis and/or pneumonia. In the UK and Ireland, each year approximately 800 babies aged 0-90 days develop GBS infection. With prompt treatment, most will make a full recovery, but sadly around 70 survivors will have long-term health issues and 50 of these very sick babies will die.
It is worrying when you see the data – presented by Public Health England (PHE) at GBSS’s June 2021 conference – which shows that England’s rate of group B Strep infection in babies rose by 77% between 1996 and 2020. 295 babies were reported as having early onset group B Strep infection in England in 1996, increasing to 520 in 2020 (more intensive investigations by the British Paediatric Surveillance Unit suggests that routine data underestimate infections by about 25%, but confirm the rising trend).
Our rate of group B Strep infection in infants is currently more than double that of many other high-income countries, most of which routinely offer all pregnant women testing rather than the risk-based approach adopted by the UK.
PHE also presented very interesting and new preliminary findings that show a baby’s genetic ancestry makes a significant difference to its chance of developing a group B Strep infection. The data also shows that Black and Asian babies are estimated to have a 36% and 17% higher risk of developing group B Strep infection compared with white babies, with only mixed-race babies having a lower risk.
The reasons for these differences are unclear but potentially reflect racial disparities that exist within other areas of maternal healthcare. PHE is currently undertaking additional work on this, and expects to publish the findings later in the year.
Most early-onset group B Strep infection can be prevented by giving women who are carrying group B Strep preventative antibiotics in labour, and the RCOG has produced a Greentop Guideline on the Prevention of early-onset neonatal group B Strep disease, last updated in 2017, which I would urge healthcare professionals to read. It included important new recommendations, including that
- all pregnant women should be provided with an information leaflet on group B Strep,
- women who had carried group B Strep in a previous pregnancy should be offered the option an Enriched Culture Medium (ECM) test in a subsequent pregnancy, and
- all women in preterm labour should be recommended to have intravenous antibiotics in labour.
Following the guideline’s publication, the RCOG and GBSS co-wrote an information leaflet, Group B Streptococcus (GBS) in pregnancy and newborn babies, for expectant and new parents, published December 2017 and available to download from both organisations and as hard-copies free to charge for families and the NHS from GBSS.
We are also awaiting the results of the ongoing GBS3 Trial comparing the UK’s current risk-based prevention strategy with two universal testing strategies – one using ECM testing and the other using bedside testing. The report is expected in 2024 and will shape future early-onset group B Strep prevention policy in the UK and beyond.
Thanks to funding from the National Lottery Community Fund, GBSS has translated the co-written RCOG/GBSS leaflet from English into 14 other languages: Arabic, Bengali, Chinese, French, Hebrew, Latvian, Lithuanian, Polish, Portuguese, Punjabi, Romanian, Somali, Urdu and Welsh. Digital copies of these leaflets are now available here.
We encourage all RCOG members to use these translations, and flag them to their maternity colleagues, so we can ensure everyone can access high-quality information on group B Strep, including where English is not their first language.
We set up GBSS with the objective of it becoming no longer needed – unfortunately we’re a long way from that, but I do believe that together we can get closer to making group B Strep infections in newborn babies a thing of the past.
This Group B Strep Awareness Month, please visit the charity’s Professional Resources page; download/order information materials; ensure your teams are fully up to speed on the latest group B Strep recommendations; and let them know that the joint RCOG/GBSS leaflet is now available in 14 additional languages.
Visit Group B Strep Support's website
Jane Plumb MBE, Chief Executive, Group B Strep Support