Stillbirths and Neonatal Deaths Caused by Group B <i>Streptococcus</i> in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS)
Sana Mahtab, Zachary J. Madewell, Shabir A. Madhi, Amy Wise, Peter J. Swart, Sithembiso Velaphi, Inácio Mandomando, Justina Bramugy, Rita Mabunda, Elísio Xerinda, Anthony Scott, Nega Assefa, Lola Madrid, Mulu Bweihun, Fikremelekot Temesgen, Dickens Onyango, Victor Akelo, Richard Oliech, Peter Otieno, Jennifer R. Verani, Shams El Arifeen, Emily S. Gurley, Muntasir Alam, Afruna Rahman, Mohammad Zahid Hossain, Samba O. Sow, Karen L. Kotloff, Milagritos D. Tapia, Adama Mamby Keita, Doh Sanogo, Ikechukwu U. Ogbuanu, Julius Ojulong, Sandra Lako, Okokon Ita, Erick Kaluma, Taís Meziara Wilson, Portia Mutevedzi, Beth A. Tippett Barr, Cynthia G. Whitney, Dianna M. Blau, Quique Bassat, Yasmin Adam, Janet Agaya, Sara Ajanovic, Addisu Alemu, Solomon Ali, George Aol, Henry Badji, Sanwarul Bari, Justina Bramugy, James Bunn, Richard Chawana, Atique Iqbal Chowdhury, Karen D. Fairchild, Surafel Fentaw, Meerjady Sabrina Flora, Dickson Gethi, Nelesh P. Govender, Carol L. Greene, Tadesse Gure, Martin Hale, Juan Carlos Hurtado, Kitiezo Aggrey Igunza, Farzana Islam, Jennifer Johnson, Tatiana Keita, Sammy Khagayi, Iqbal Ansary Khan, Rima Koka, Diakaridia Kone, Nana Kourouma, Magdalene Kuria, Sandra Lako, Sanjay G. Lala, Hennie Lombaard, Ronita Luke, Thomas Misore, Paul K Mitei, Alexander M. Ibrahim, Andrew Moultrie, Florence Murila, Nellie Myburgh, Peter Nyamthimba, Richard Oliech, Richard Omore, Uma U. Onwuchekwa, Stian Magnus Staurung Orlien, Louis Othieno, Peter Otieno, Kephas Otieno, Gregory Ouma, Benard Owuor, Shahana Parveen, Karen L. Petersen, Mahbubur Rahman, Natalia Rakislova, Emily Rogena, Doh Sanogo, Tahmina Shirin, Diakaridia Sidibé
Abstract
Abstract Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to &lt;24 hours, n = 597), early neonatal deaths (END) (1 day to &lt;7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to &lt;24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed &lt;2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths &lt;90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.