Invasive group B Strep disease in England & Wales doubles between 1991 and 2010

A paper has been published on invasive group B Strep disease in England and Wales between 1991 & 2010 in the Clinical Infectious Diseases Journal. (Emerging Trends in the Epidemiology of Invasive Group B Streptococcal Disease in England and Wales,1991-2010. Lamangi TL. Clin Inf Dis. Jul 2013 - see ncbi.nlm.nih.gov/pubmed/238...

Over the past 20 years, invasive group B Strep infection rates in England and Wales have more than doubled (from 1.48 cases per 100,000 resident population in 1991 to 2.99 in 2010, an average increase of 5% per year). An increasing proportion of invasive GBS disease is in adults, although disease in babies has also risen.

Early onset GBS infection (age 0-6 days) increased from 0.30 cases per 1,000 live births in 1991, to 0.41 in 2010 (up 36%)

Late onset GBS infection (age 7-90 days) increased from 0.11 cases per 1,000 live births in 1991, rising to 0.29 in 2010 (up 164%)

Erythromycin-resistant GBS has increased (from <3% in the first half of the 1990s to 15% in 2010), as has clindamycin-resistant GBS (from 3% in 1998 to 9% in 2010). The authors report that there have been no confirmed cases of penicillin-resistant GBS in the UK to date. These findings support the recommendation of NICE's Antibiotics for early-onset Neonatal Infection Guideline, "Offer benzylpenicillin as the first choice for intrapartum antibiotic prophylaxis. If the woman is allergic to penicillin, offer clindamycin unless individual group B streptococcus sensitivity results or local microbiological surveillance data indicate a different antibiotic."

Early onset GBS infection increased on average by 1% per annum between 1991 and 2010, with rates increasing by 5% a year since 2005. It is disappointing this rise in the years since the Royal College of Obstetricians & Gynaecologists' 2003 guideline. Although there was a small reduction following its introduction (from 0.35 to 0.31 cases per 1,000 live births between 2003 and 2005), this returned to the same rate by 2006, and hit a high in 2010 of 0.41 cases per 1,000 live births. What more evidence do we need that this approach simply isn't working?

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