http://www.fitango.com/categories.php?id=513

Fitango EducationHealth Topics

Group B strep

1

Overview

Group B Streptococcus (group B strep) is a type of bacteria that causes illness in people of all ages. Also known as GBS or baby strep, group B strep disease in newborns most commonly causes sepsis (infection of the blood), pneumonia (infection in the lungs), and sometimes meningitis (infection of the fluid and lining around the brain). The most common problems caused by group B strep in adults are bloodstream infections, pneumonia, skin and soft-tissue infections, and bone and joint infections.

2

Overview

Centers for Disease Control and Prevention:

http://www.cdc.gov/groupbstrep/about/index.html

3

Symptoms

The symptoms of group B strep disease can seem like other health problems in newborns and infants. Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of group B strep disease after the first week of life.

Some symptoms are:

4

Symptoms

-- Fever

-- Difficulty feeding

-- Irritability, or lethargy (limpness or hard to wake up the baby)

-- Difficulty breathing

-- Blue-ish color to skin

5

Symptoms

Centers for Disease Control and Prevention:

6

Diagnosis

Group B strep disease is diagnosed when the bacteria are grown from samples of a baby’s sterile body fluids, such as blood or spinal fluid. Cultures can take a few days to grow.

7

Diagnosis

Typically, if a mother who tested positive for group B strep received antibiotics during labor, the baby will be observed to see if he or she should get extra testing or treatment because of concerns about early-onset disease. (See the secondary prevention of early-onset GBS among infants section of the CDC’s prevention guidelines to learn more.)

8

Diagnosis

For both early-onset and late-onset disease, if the doctors suspect that a baby has group B strep infection, they will take a sample of the baby’s blood and spinal fluid to confirm the diagnosis.

Centers for Disease Control and Prevention:

http://www.cdc.gov/groupbstrep/about/index.html

9

Treatment

Group B strep infections in newborns and older babies are treated with antibiotics (e.g., penicillin or ampicillin) given through a vein (IV). For babies with severe illness, other procedures in addition to antibiotics may be needed.

Centers for Disease Control and Prevention:

10

Treatment

Group B strep infections in newborns and older babies are treated with antibiotics (e.g., penicillin or ampicillin) given through a vein (IV). For babies with severe illness, other procedures in addition to antibiotics may be needed.

Centers for Disease Control and Prevention:

11

Risks**Transmission**

For early-onset disease, the group B strep bacteria are passed from the mother to the baby, most often during labor and birth. Antibiotics given during labor can be very effective at preventing this transmission.

12

Risks**Transmission**

Late-onset disease is sometimes due to passing of the bacteria from mother to newborn, but sometimes the bacteria come from another source. For a baby whose mother does not test positive for group B strep, the source of infection for late-onset disease can be hard to figure out and is often unknown. CDC collects information on babies with late-onset disease in 10 states to better understand transmission.

13

Risks**Transmission**

Women who are group B strep positive can breastfeed safely. There are many benefits for both the mother and child.

**Risk Factors**

Some pregnant women are at higher risk of having a baby with early-onset disease. The factors that increase risk include:

14

Risks**Transmission**

Testing positive for group B strep late in the current pregnancy (35-37 weeks gestation)

Detecting group B strep in urine during the current pregnancy

Delivering early (before 37 weeks gestation)

Developing fever during labor

15

Risks**Transmission**

Having a long period between water breaking and delivering

Having a previous infant with early-onset disease

These risk factors guided the early-onset disease prevention strategy used today.

16

Risks**Transmission**

Late-onset disease is more common among babies who are born prematurely (< 37 weeks). This is the strongest risk. Babies whose mothers tested group B strep positive also have a higher risk of late onset disease. The risk factors for late onset disease are not as well understood as for early-onset disease.

Centers for Disease Control and Prevention:

17

Risks**Transmission**

http://www.cdc.gov/groupbstrep/about/index.html

18

Prevention

Preventing Early-Onset GBS

There are 2 cornerstones to preventing newborn early-onset disease: testing all pregnant women for group B strep bacteria late in pregnancy, and giving antibiotics during labor to women who test positive for the bacteria.

1. Testing Pregnant Women

19

Prevention

CDC’s guidelines recommend that a pregnant woman be tested, or screened, for group B strep in her vagina and rectum when she is 35 to 37 weeks pregnant. The test is simple and does not hurt. A sterile swab (“Q-tip”) is used to collect a sample from the vagina and the rectum. This is sent to a laboratory for testing.

20

Prevention

About 25% of pregnant women carry group B strep in the rectum or vagina. Those women are considered group B strep positive. A woman may test positive at certain times and not at others. That’s why it’s important for all pregnant women to be tested for group B strep between 35 to 37 weeks of every pregnancy.

21

Prevention

A woman who has the bacteria in her body usually does not feel sick or have any symptoms. However, she is at higher risk for passing group B strep to her baby during birth.

Women should talk to their doctor about their group B strep status.

2. Antibiotics During Labor

22

Prevention

To help protect their babies from infection, pregnant women who test positive for group B strep in the current pregnancy should receive antibiotics (medicine) through the vein (IV) during labor. Also, pregnant women who have group B strep detected in their urine during the current pregnancy or who had a previous infant with group B strep disease should receive antibiotics during labor; they do not need to be screened at 35-37 weeks because they should receive antibiotics regardless of the screen

23

Prevention

Pregnant women who do not know whether or not they are group B strep positive when labor starts should be given antibiotics if they have: labor starting at less than 37 weeks (preterm labor); prolonged membrane rupture (water breaking 18 or more hours before delivery); or fever during labor.

24

Prevention

Antibiotics help to kill some of the group B strep bacteria that are dangerous to the baby during birth. The antibiotics help during labor only — they can’t be taken before labor, because the bacteria can grow back quickly. Penicillin is the most common antibiotic that is given. For women who are severely allergic to penicillin, there are other antibiotics that can be given. Women should tell their doctor or nurse about any allergies during a checkup and try to make a plan for delivery. When

25

Prevention

Penicillin is very safe and effective at preventing group B strep disease in newborns. There can be side effects from penicillin for the woman, including a mild reaction to penicillin (about a 10% chance). There is a rare chance (about 1 in 10,000) of the mother having a severe allergic reaction that requires emergency treatment.

Preventing Late-Onset Disease

26

Prevention

Unfortunately, the method recommended to prevent early-onset disease (giving women who are group B strep positive antibiotics through the vein (IV) during labor) does not prevent late-onset disease. Although rates of early-onset disease have declined, rates of late-onset disease have remained fairly stable since 1990. At this time, a strategy has not yet been identified for preventing late-onset group B strep disease.

27

Prevention

Alternative Prevention Strategies

28

Prevention

There is no group B strep vaccine currently available to help mothers protect their newborns from group B strep disease. Researchers are working on developing a vaccine, which may become available one day in the future. Antibiotics taken by mouth instead of through the vein, and antibiotics taken before labor and delivery are not effective at preventing newborn group B strep disease. Birth canal washes with the disinfectant chlorhexidine do not reduce mother to baby transmission of group B stre

29

Prevention

Centers for Disease Control and Prevention:

http://www.cdc.gov/groupbstrep/about/index.html

30

Facts

-- In the U.S., group B strep is the leading cause of meningitis (infection of the fluid and lining around the brain) and sepsis (infection of the blood) in a newborn’s first week of life (early-onset disease).

31

Facts

-- About 25% of pregnant women carry group B strep in the rectum or vagina. Group B strep bacteria may come and go in people’s bodies without symptoms.

-- CDC’s guidelines recommend that a pregnant woman be tested for group B strep when she is 35 to 37 weeks pregnant.

32

Facts

-- A pregnant woman who tests positive for group B strep and gets antibiotics during labor has only a 1 in 4,000 chance of delivering a baby with group B strep disease, compared to a 1 in 200 chance if she does not get antibiotics during labor.

33

Facts

-- Any pregnant woman who had a baby with group B strep disease in the past, or who has had a bladder (urinary tract) infection during this pregnancy caused by group B strep should receive antibiotics during labor.

-- Most early-onset group B strep disease in newborns can be prevented by giving pregnant women antibiotics (medicine) through the vein (IV) during labor.

34

Facts

-- Newborns are at increased risk for a group B strep infection if their mother tests positive for group B strep during pregnancy.

-- The antibiotics used to prevent early-onset group B strep disease in newborns only help during labor — they can’t be taken before labor, because the bacteria can grow back quickly.

35

Facts

-- The rate of serious group B strep disease increases with age; average age of cases in non-pregnant adults is about 60 years old.

Centers for Disease Control and Prevention:

http://www.cdc.gov/groupbstrep/about/index.html