Thanks to Bounty’s ‘Word of Mum’ Research Panel1, we recently learned that of the 4,673 new and expectant mums who took part, 53% had NOT heard of group B Strep. 96% believe all women in the UK should be informed about group B Strep as a matter of course during their pregnancy, with 93% saying all pregnant women should be offered a test specifically to detect group B Strep carriage.
94% agreed they would want to take a group B Strep-specific (such as the Enriched Culture Medium or ECM test) during the current pregnancy if it were available for free on the NHS. There is not usually the option to have the ECM test free via the NHS, and 91% said that all pregnant women should be told about the option to have the test privately. 58% said they would pay £35 to have the test privately. The cost factor alone of the private test is discouraging 27% of women, with the remaining 15% saying they did not think the test is needed. The issue of affordability is understandable but pours salt into the wound made by Public Health England’s 180 degree turn at the end of 2013. We were so close to this test being freely available..
For those who don’t know, under the cover of Christmas 2013 Public Health England (PHE) made a devastating U-turn. The policy decision to make a test specifically for group B Strep carriage available for health professionals to request for pregnant women in their care was revoked, just days before its scheduled start date of 1 January 2014.
Early that January, Group B Strep Support met with PHE and Department of Health officials who maintained, “there is no indication for testing high-risk women using ECM methods within current clinical guidelines from the national Institute for Health and Care Excellence and therefore it would be inappropriate to make this test routinely available." This, however, was not the position in December 2012 when the Chief Medical Officer, Prof Dame Sally Davies, agreed to ensure that GBS-specific testing would be made available for health professionals to request.
The GBS-specific Enriched Culture Medium (ECM) GBS-specific test has been available for almost twenty years in other countries and is recognised as the 'gold standard' for detecting group B Strep carriage. PHE has a UK Standard (SMI B58) describing the method, first published in 20062.
The conventional NHS swab test is poor at detecting group B Strep carriage. This is the swab test used to investigate vaginal symptoms, such as discharge or irritation and uses a Standard Direct Plating technique3. Although positive results are reliable, this test gives a high proportion of falsely negative results. Group B Strep will only be isolated in up to 50% of cases where the Mum is carrying group B Strep when the swab was taken. (To read more of the differences between tests, click here.)
This devastating revocation against making this improved test available ties the hands of health professionals. They remain unable to request a group B Strep -specific test on the NHS when, in their professional opinion, they believe it appropriate for a pregnant woman in their care. This decision also continues to puts babies’ lives at risk while leaving the UK way behind other developed countries.
The ‘Word of Mum’ research also found that only 34% of women knew about group B Strep from midwives, GPs or antenatal classes while 66% had heard of it from other sources such as a friend and/or pregnancy book or magazine. Even though routine antenatal screening for group B Strep carriage is not currently recommended by the Royal College of Obstetricians & Gynaecologists (RCOG) or the National Screening Committee (NSC), it’s important that our health professionals are at least educated about it. And despite lack of testing, both the RCOG and National Institute for Health and Care Excellence (NICE) have guidelines for the prevention of early-onset group B Strep infection.4-5 We, at Group B Strep Support, happily offer all our information materials (leaflets, posters, guidelines and alert stickers) to health professionals for free!
The fact that knowledge of group B Strep among pregnant women is coming mostly from word of mouth, or literally word of mum, is in line with the recent RCOG 2015 Audit findings6. Of the 55.9% of UK obstetric units that are offering testing to some or all pregnant women for group B Strep carriage, 76% of these units are doing so at the mother’s request! Regrettably, most of those units are offering the conventional NHS swab test instead of the GBS specific ECM… which brings us back to the initial problem. Why are we using a test to detect group B Strep carriage that we know misses up to HALF of all carriers?
The ECM test, which provides positive results with 87% accuracy and negative results with 96% accuracy7, is not expensive. PHE estimated the cost to only be £11 a test. There are significant consequences in using a test that produces such a high proportion of falsely negative results. If a woman carrying group B Strep is not offered intravenous antibiotics in labour because of a false-negative test result, her baby could develop an otherwise preventable group B Strep infection.
This research shows that while there is still room for improvement, a growing proportion of women had been able to find all the information they needed about group B Strep.
We want more health professionals to be informing mums in their care about group B Strep carriage and the potential risks of infection. We also want them to have the best tool for the job!
With Group B Strep Awareness Month coming up in July, be watching for a new group B Strep e-petition. It is time. Let’s make this change!
References:
1 2015_Bounty_Group_B_Strep_Research – comparing results from their 2010,2011,2013 and 2015 Survey – Awareness and Perception of group B Strep – conducted between 16-31 March 2015. Base survey 4,673 interviews, women in early stages of pregnancy and youngest child 12 months.
2 Public Health England’s UK Standards for Microbiology Investigations B 58 Processing Swabs for Group B Streptococcal Carriage (issued 2006, updated 2014) – testing specifically for group B Strep carriage
3 Public Health England’s UK Standards for Microbiology Investigations B 28 Investigation of Genital Tract and Associated Specimens (issued 2003, updated 2014) – non-specific testing.
4 Royal College of Obstetricians & Gynaecologists Clinical Green Top Guideline No 36 Prevention of early onset neonatal GBS disease (issued 2003, updated 2012)
5 National Institute for Health & Care Excellence Antibiotics for the prevention and treatment of early-onset neonatal infection (2012)
6 Royal College of Obstetricians & Gynaecologists Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK. First Report (2015)
7 The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. Obstet Gynecol. 1996 Nov;88(5):811-5. Am J Obstet Gynecol. 1984 Apr 1;148(7):915-28.