Infection

, Volume 45, Issue 4, pp 449–458 | Cite as

Group B streptococcal disease in infants in the first year of life: a nationwide surveillance study in Japan, 2011–2015

  • Kousaku Matsubara
  • Kiyoshi Hoshina
  • Masatoshi Kondo
  • Isao Miyairi
  • Yoshiya Yukitake
  • Yusuke Ito
  • Kisei Minami
  • Ryuichi Genkawa
Original Paper

Abstract

Purpose

This study aimed to describe the epidemiology of childhood group B streptococcus (GBS) disease including late late-onset disease (LLOD) and to clinically characterize recurrent cases and twin-sibling cases in Japan.

Methods

We collected information on infants (<1 year of age) with invasive GBS disease and institutional information about births and transfers through a nationwide questionnaire between 2011 and 2015.

Results

We identified 133 infants with early-onset disease (EOD), 274 late-onset disease (LOD), and 38 LLOD from 149 institutes. The case fatality rate (CFR) of EOD, LOD, and LLOD was 4.5, 4.4, and 0%, respectively. CFR in EOD was significantly (P < 0.001) associated with preterm birth, but not that in LOD and LLOD. Twenty-nine percent of infants with meningitis (49/169) had neurologic sequelae. We showed clinical details of 12 recurrent cases that accounted for 2.8% of the total patients, and 4 sets of both twins affected; 4 of 12 recurrent cases and 3 of 4 twin-sibling sets were also associated with preterm birth. Based on the livebirth number of 581,488, the instituted-based incidence of EOD, LOD, and LLOD was estimated as 0.09 (95% CI 0.06–0.11), 0.12 (95% CI 0.11–0.14), and 0.01 (95% CI 0.01–0.02) per 1000 livebirths, respectively.

Conclusions

CFR of EOD and LOD in Japan is comparable with that in high-income European countries or the United States, and their incidence is much lower. Our findings also describe the clinical details of LLOD, recurrent infections, and infections in twin siblings. This study is the largest among Asian childhood GBS studies ever reported.

Keywords

Streptococcus agalactiae Group B Streptococcus Epidemiology Japan Recurrence Twin 

Notes

Author contribution

Ko.M. and K.H. designed the study and drafted the manuscript; M.K., I.M., Y.Y., Y.I., Ki.M., and R.G. analyzed data and gave conceptual advice. All authors read and approved the final manuscript as submitted.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest associated with this manuscript.

References

  1. 1.
    Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AK, Cousens S, Heath PT. Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. Lancet. 2012;347:547–56.CrossRefGoogle Scholar
  2. 2.
    Melin P. Neonatal group B streptococcal disease: from pathogenesis to preventive strategies. Clin Microbiol Infect. 2011;17:1294–303.CrossRefPubMedGoogle Scholar
  3. 3.
    Edwards MS, Nizet V, Baker CJ. Group B streptococcal infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, editors. Remington and Klein’s Infectious Diseases of the Fetus and Newborn Infant. 8th ed. Philadelphia: Elsevier Saunders; 2016. p. 411–56.Google Scholar
  4. 4.
    Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, Craig AS, Schaffner W, Zansky SM, Gershman K, Stefonek KR, Albanese BA, Zell ER, Schuchat A, Schrag SJ, Active Bacterial Core surveillance/Emerging Infections Program Network. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008;299:2056–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Hussain SM, Luedtke GS, Baker CJ, Schlievert PM, Leggiadro RJ. Invasive group B streptococcal disease in children beyond early infancy. Pediatr Infect Dis J. 1995;14:278–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Guilbert J, Levy C, Cohen R. Bacterial meningitis group, Delacourt C, Renolleau S, Flamant C. Late and ultra late onset Streptococcus B meningitis: clinical and bacteriological data over 6 years in France. Acta Paediatr. 2010;99:47–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Dagnew AF, Cunnington MC, Dube Q, Edwards MS, French N, Heyderman RS, Madhi SA, Slobod K, Clemens SA. Variation in reported neonatal group B streptococcal disease incidence in developing countries. Clin Infect Dis. 2012;55:91–102.CrossRefPubMedGoogle Scholar
  8. 8.
    Sridhar S, Grace R, Nitya PJ, Balaji V, Niranjan T, Manish K, Anil KK, Atanu JK. Group B streptococcal infection in a tertiary hospital in India -1998-2010. Pediatr Infect Dis J. 2014;33:1091–2.CrossRefPubMedGoogle Scholar
  9. 9.
    Hoshina K, Suzuki Y, Nishida H, Kaneko K, Matsuda S, Kobayashi M, Kadoi N. Trend of neonatal group B streptococcal infection during the last 15 years. Pediatr Int. 2002;44:641–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Matsubara K, Hoshina K, Suzuki Y. Early-onset and late-onset group B streptococcal disease in Japan: a nationwide surveillance study, 2004-2010. Int J Infect Dis. 2013;17:e379–84.CrossRefPubMedGoogle Scholar
  11. 11.
    Minakami H, Maeda T, Fujii T, Hamada H, Iitsuka Y, Itakura A, Itoh H, Iwashita M, Kanagawa T, Kanai M, Kasuga Y, Kawabata M, Kobayashi K, Kotani T, Kudo Y, Makino Y, Matsubara S, Matsuda H, Miura K, Murakoshi T, Murotsuki J, Ohkuchi A, Ohno Y, Ohshiba Y, Satoh S, Sekizawa A, Sugiura M, Suzuki S, Takahashi T, Tsukahara Y, Unno N, Yoshikawa H. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition. J Obstet Gynaecol Res. 2014;40:1469–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Morozumi M, Wajima T, Kuwata Y, Chiba N, Sunaoshi K, Sugita K, Sakata H, Iwata S, Ubukata K. Associations between capsular serotype, multilocus sequence type, and macrolide resistance in Streptococcus agalactiae isolates from Japanese infants with invasive infections. Epidemiol Infect. 2014;142:812–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Joubrel C, Tazi A, Six A, Dmytruk N, Touak G, Bidet P, Raymond J, Trieu Cuot P, Fouet A, Kernéis S, Poyart C. Group B streptococcus neonatal invasive infections, France 2007–2012. Clin Microbiol Infect. 2015;21:910–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Berardi A, Lugli L, Baronciani D, Creti R, Rossi K, Ciccia M, Gambini L, Mariani S, Papa I, Serra L, Tridapalli E, Ferrari F, GBS Prevention Working Group of Emilia-Romagna. Group B streptococcal infections in a northern region of Italy. Pediatrics. 2007;120:e487–93.CrossRefPubMedGoogle Scholar
  15. 15.
    Heath PT, Balfour G, Weisner AM, Efstratiou A, Lamagni TL, Tighe H, O’Connell LA, Cafferkey M, Verlander NQ, Nicoll A, McCartney AC, PHLS Group B Streptococcus Working Group. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet. 2004;363:292–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Fluegge K, Siedler A, Heinrich B, Schulte-Moenting J, Moennig MJ, Bartels DB, Dammann O, von Kries R, Berner R, German Pediatric Surveillance Unit Study Group. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics. 2006;117:e1139–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Giannoni E, Berger C, Stocker M, Agyeman P, Posfay-Barbe KM, Heininger U, Konetzny G, Niederer-Loher A, Kahlert C, Donas A, Leone A, Hasters P, Relly C, Baer W, Aebi C, Schlapbach LJ, Swiss Pediatric Sepsis Study Group. Incidence and outcome of group B streptococcal sepsis in infants in Switzerland. Pediatr Infect Dis J. 2016;35:222–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Centers for Disease Control and Prevention. Active bacterial core surveillance report, Emerging infections program network, group B Streptococcus, 2014. Available at: http://www.cdc.gov/abcs/reports-findings/survreports/gbs14.pdf. Accessed 10 October 2016.
  19. 19.
    Libster R, Edwards KM, Levent F, Edwards MS, Rench MA, Castagnini LA, Cooper T, Sparks RC, Baker CJ, Shah PE. Long-term outcomes of group B streptococcal meningitis. Pediatrics. 2012;130:e8–15.CrossRefPubMedGoogle Scholar
  20. 20.
    Green PA, Singh KV, Murray BE, Baker CJ. Recurrent group B streptococcal infections in infants: clinical and microbiological aspects. J Pediatr. 1994;125:931–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Atkins JT, Heresi GP, Coque TM, Baker CJ. Recurrent group B streptococcal disease in infants: Who should receive rifampin? J Pediatr. 1998;132:537–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Moylett EH, Fernandez M, Rench MA, Hickman ME, Baker CJ. A 5-year review of recurrent streptococcal disease: lessons from twin infants. Clin Infect Dis. 2000;30:282–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Elling R, Hufnagel M, de Zoysa A, Lander F, Zumstein K, Krueger M, Henneke P. Synchronous recurrence of group B streptococcal late-onset sepsis in twins. Pediatrics. 2014;133:e1388–91.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Filleron A, Lombard F, Jacquot A, Jumas-Bilak E, Rodière M, Cambonie G, Marchandin H. Group B streptococci in milk and late neonatal infections: an analysis of cases in the literature. Arch Dis Child Fetal Neonat Ed. 2014;99:F41–7.CrossRefGoogle Scholar
  25. 25.
    Edwards MS, Jackson CV, Baker CJ. Increased risk of group B streptococcal disease in twins. JAMA. 1981;245:2044–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Arora HS, Chiwane SS, Abdel-Haq N, Valentine K, Laphart P, Asmar RI. Group B streptococcus sepsis in twins. Pediatr Infect Dis J. 2015;34:548–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Fluegge K, Supper S, Siedler A, Berner R. Serotype distribution of invasive group B streptococcal isolates in infants: results from a nationwide active laboratory surveillance study over 2 years in Germany. Clin Infect Dis. 2005;40:760–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Bekker V, Bijlsma MW, van de Beek D, et al. Incidence of invasive group B streptococcal disease and pathogen genotype distribution in newborn babies in the Netherlands over 25 years: a nationwide surveillance study. Lancet Infect Dis. 2014;14:1083–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Lamagni TL, Keshishian C, Efstratiou A, Kuijpers TW, van der Ende A. Emerging trends in the epidemiology of invasive group B streptococcal disease in England and Wales, 1991–2010. Clin Infect Dis. 2013;57:682–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Donders GG, Halperin SA, Devlieger R, Baker S, Forte P, Wittke F, Slobod KS, Dull PM. Maternal immunization with an investigational trivalent group B streptococcal vaccine: a randomized controlled trial. Obstet Gynecol. 2016;127:213–21.CrossRefPubMedGoogle Scholar
  31. 31.
    Bisharat N, Crook DW, Leigh J, Bisharat N, Crook DW, Leigh J. Hyperinvasive neonatal group B streptococcus has arisen from a bovine ancestor. J Clin Microbiol. 2004;42:2161–7.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Jones N, Oliver KA, Barry J, Harding RM, Bisharat N, Spratt BG, Peto T, Crook DW, Oxford Group B Streptococcus Consortium. Enhanced invasiveness of bovine-derived neonatal sequence type 17 group B Streptococcus is independent of capsular serotype. Clin Infect Dis. 2006;42:915–24.CrossRefPubMedGoogle Scholar
  33. 33.
    Chang B, Wada A, Hosoya M, Oishi T, Ishiwada N, Oda M, Sato T, Terauchi Y, Okada K, Nishi J, Akeda H, Kamiya H, Ohnishi M, Ihara T, Japanese Invasive Disease Study Group. Characteristics of group B Streptococcus isolated from infants with invasive infections: a population-based study in Japan. Jpn J Infect Dis. 2014;67:356–60.CrossRefPubMedGoogle Scholar
  34. 34.
    http://www.nih.go.jp/niid/ja/iasr-sp/2316-related-articles/related-articles-426/5883-dj4269.html. Infectious Agents Surveillance Report (IASR) 2015; 36:158-9 (in Japanese).
  35. 35.
    Afshar B, Broughton K, Creti R, Decheva A, Hufnagel M, Kriz P, Lambertsen L, Lovgren M, Melin P, Orefici G, Poyart C, Radtke A, Rodriguez-Granger J, Sørensen UB, Telford J, Valinsky L, Zachariadou L, Members of the DEVANI Study Group, Efstratiou A. International external quality assurance for laboratory identification and typing of Streptococcus agalactiae (Group B streptococci). J Clin Microbiol. 2011;49:1475–82.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Kousaku Matsubara
    • 1
  • Kiyoshi Hoshina
    • 2
  • Masatoshi Kondo
    • 3
  • Isao Miyairi
    • 4
  • Yoshiya Yukitake
    • 5
  • Yusuke Ito
    • 6
  • Kisei Minami
    • 7
  • Ryuichi Genkawa
    • 8
  1. 1.Department of PediatricsNishi-Kobe Medical CenterKobeJapan
  2. 2.Department of PediatricsSanno HospitalTokyoJapan
  3. 3.Department of NeonatologyTokyo Metropolitan Children’s Medical CenterTokyoJapan
  4. 4.Division of Infectious DiseasesNational Center for Child Health and DevelopmentTokyoJapan
  5. 5.Department of NeonatologyIbaraki Children’s HospitalIbarakiJapan
  6. 6.Department of Pediatric Intensive CareShizuoka Children’s HospitalShizuokaJapan
  7. 7.Department of General PediatricsNagano Children’s HospitalAzuminoJapan
  8. 8.Department of NeonatologyOkinawa Chubu HospitalUrumaJapan

Personalised recommendations