October 8, 2014: “A Simple Test to Save a Life”
*Welcome to the GBSS Blog/ Editor’s Note:
We have been going back and forth with the idea of a blog for a while. It seemed the only thing missing from our online repertoire and yet we couldn’t quite agree on its necessity, usefulness, or the most advantageous platform. Then recently something became undeniably clear. No matter how many Tweets or Facebook posts we may put out, Social Media turnover is so high that unfortunately valuable information is easily lost or missed completely. (If your newsfeeds are anything like ours, you know what we mean.) This high turnover coupled with our society’s tendency to rely on the oracle that is, apparently, Google, leads not only to lost information but also MIS-information. Right then. Time for a blog! A blog on a static platform where each and every post can be easily seen and accessed. A medically accurate, understandable, and supportive blog to help steer people away from the fear inducing Google search results. Here it is and here we are. Welcome to our inaugural post!
A Simple Test to Save a Life
In light of Baby Loss Awareness Week October 9-15th, Group B Strep Support wanted to contribute to such a beautiful and important week with the gift of knowledge. While group B Strep usually causes no problems, unfortunately it is the most common cause of serious infection in newborn babies and meningitis in babies under three months. Even more unfortunately it can contribute to some of these infant losses since 1/10 babies sick with group B Strep infection will die.
Group B Strep Support believes all pregnant women should be informed about group B Strep and that all low-risk women should be offered the opportunity to have a sensitive test for the detection of GBS carriage late in pregnancy (35-37wks). So let’s discuss some of our most frequently asked questions explaining the Who, What, Where, When and Why of group B Strep…although not necessarily in that order.
1)First all, what IS group B Strep? We get a fair number of calls and emails from women and their partners who fear GBS to be a disease, a lifetime diagnosis and/or a virus.
a.Actually, group B Streptococcus is a natural and normal bacterium that colonises in 30% of all adults (men and women) without symptoms or side-effects. It is most commonly found in the intestines as part of your normal and friendly ‘gut’ flora. It is also found in the vagina living as a ‘commensal’ – an organism which lives on another without causing any harm. GBS can, however, occasionally cause infection, most commonly in newborn babies which can lead to septicaemia, pneumonia, and meningitis.
b.What it is NOT: GBS is not a sexually transmitted disease. Carrying GBS does not require treatment of the woman or of her partner and treatment does not prevent re-colonisation anyway.
2)“My Dr/Midwife says testing is not recommended and not to worry, so why should I get tested?”
a.True. Routine screening of all pregnant women for GBS is not recommended by the UK National Screening Committee nor the Royal College of Obstetricians & Gynaecologists. In lieu of testing, they recommend a ‘risk factor’ approach to determine which babies are more likely to develop group B Strep infection. These risk factors include Mum carrying GBS this pregnancy, high temperature during labour, labour starting or waters breaking prematurely and having previously had a baby infected with group B Strep.
b.That being said, clinical risk factors are not accurate predictors of group B Strep infection in babies as 4/10 of the newborn babies who develop group B Strep infection have NO known risk factors. 5/10 newborn babies who die from group B Strep infection also had no known risk factors.
c.So why test? Why not?! With infections as serious as those caused by GBS, prevention is so much better than treatment! Knowing the result of a test sensitive for GBS test is always good news. If it’s positive, although it does mean that the baby is at a raised risk of developing GBS infection, it also means that – as the GBS carriage has been identified – simple, straightforward steps can be taken which have been proven to be extremely effective at minimising that risk.
3)Okay, I want a test. Where do I go? What do I ask for? When should I have it?
a.(Please know that even though routine testing is not recommended, you can still ask for one from your NHS or you can also request a private home test. Speak up.) 35-37 weeks is suggested for testing, as this has shown to be a highly predictive indicator of whether you will be carrying when you go into labour. There are 3 different kinds of tests so it is important to know what is being offered. There is the Standard Direct Plating method which is the conventional NHS test, the ECM or Enriched Culture Medium method recognised as the gold standard for detecting GBS, and the Polymerase Chain Reaction method which is not widely available in the UK. While a handful of hospitals do offer the ‘gold standard’ ECM test, if yours does not there is a home-testing pack that is available privately for around £35.
b.Are the tests accurate? ... It depends.
i.A positive result from Standard Direct Plating (HVS), the conventional NHS test, is highly reliable, but a negative one is not. Only around 50% of women who are carrying GBS when the swabs are taken will correctly be told they carry GBS – the other half will be incorrectly told they are not. So trust a positive direct plating result, but be wary of a negative one.
ii.The ECM test is considered the gold standard for detecting GBS. The test is highly sensitive and if performed within 5 weeks of delivery, a negative result is 96% predictive of not carrying at delivery and a positive result is 87%.
4)“The test came back positive, now what? What is the chance of my baby becoming infected? ”
a.Remember, knowing you are a carrier is good news because now you can take the appropriate preventative measures. Any positive GBS test result during pregnancy means that the pregnant woman should be offered intravenous antibiotics (Pencillin or, for women who are allergic to pencillin, there are alternatives) from the start of labour or waters breaking and then usually at 4 hour intervals until delivery. Intravenous antibiotics given in labour to mums carrying group B Strep reduce infection in babies by 90%! (Side note: If you’d like a ‘GBS Alert’ sticker to put on your hand-held pregnancy notes to remind your health professionals about the intravenous antibiotics in labour, you can download one from our website at gbss.org.uk. Of course, it won’t be sticky, so if you’d like us to send you one in the post, please contact us with your postal address and/or send us a self-addressed envelope marked ‘Alert’ and we’ll put a couple in the post.) As for the chance of a baby becoming infected, there is a 1/300 chance if Mum is a carrier and no preventative antibiotics are given. There is a 1/6000 if Mum is a carrier and has the appropriate preventative antibiotics in labour. Remember what you just read, infection is reduced by 90% with IV antibiotics!
If you’ve never before heard of group B Strep then you may still have tons of questions, understandably as it can be a lot to take in at first. Hopefully though we’ve laid a solid foundation here upon which you can build your understanding and GBS awareness. If you had heard of group B Strep and were scared from what you might’ve read elsewhere online, then hopefully too we’ve eased your concern. A helpful way to keep all this information in perspective is to remember M.U.M.M.Y:
M – many women carry group B Strep naturally
U- usually causes no problems, but can be devastating
M – most common cause of serious infection in newborns and meningitis in babies < 3 mo
M – most group B Strep infections in babies are preventable
Y- your knowledge can help protect your baby
Please visit our website (gbss.org.uk) which has a wealth of information, answers to all of your questions, and leaflets/posters/stickers that are all FREE to download. We also love this interview with Dr. Chris Steele, our very own Group B Strep Support patron: itv.com/news/granada/story/...
**Medical references and studies available upon request.