南亚和非洲低收入和中等收入国家母婴二人组中 B 群链球菌定植的流行率：一项前瞻性观察研究。

IF 20.9 1区生物学 Q1 INFECTIOUS DISEASES

Lancet Microbe Pub Date : 2024-10-01 DOI:10.1016/S2666-5247(24)00129-0

Gaurav Kwatra PhD , Alane Izu PhD , Clare Cutland PhD , Godwin Akaba MPH , Musa Mohammed Ali PhD , Zabed Ahmed MSc , Prof Manisha Madhai Beck MD , Hellen Cherono Barsosio MBBS , Prof James A Berkley MD , Tolossa E Chaka MD , Anélsio Cossa MSc , Sowmitra Chakraborty MSc , Nisha Dhar PhD , Phurb Dorji MD , Maksuda Islam PhD , Adama Mamby Keita MD , Stella Mwakio MD , Salim Mwarumba MSc , Nubwa Medugu MD , Helio Mucavele MD , Prof Shabir A Madhi PhD

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引用次数: 0

摘要

背景：孕妇在分娩时直肠阴道B群链球菌（GBS）定植是7天内发生侵袭性GBS疾病（早发疾病）的主要风险因素。我们的目的是调查选定的中低收入非洲国家和南亚国家孕妇在分娩时直肠阴道 GBS 定植的流行率及其对新生儿的垂直传播：这项前瞻性观察研究在埃塞俄比亚、肯尼亚、莫桑比克、尼日利亚、马里、南非、孟加拉国、印度和不丹的 11 家妇产医院进行。年龄在 18-45 岁之间、处于分娩早期阶段、妊娠至少 37 周的 HIV 阴性孕妇均符合纳入研究的条件。从孕妇身上采集下阴道拭子、直肠拭子和尿液，从新生儿身上采集脐部、外耳、腋窝、直肠和咽喉拭子，进行 GBS 培养。各医疗点均采用标准化的采样和培养方法，使用直接平板和选择性培养基肉汤检测 GBS 定植情况。在南非对分离出的 GBS 进行了血清分型。主要结果是孕妇直肠阴道 GBS 患病率，分析对象为有数据的参与者。该研究已在南非国家临床试验登记处登记，编号为 DOH-27-0418-4989：从2016年1月10日到2018年12月11日，共登记了6922名孕妇，其中6514名（94-1%；每个国家759-892名）纳入分析；由于标本采集和处理问题，不丹的数据未纳入研究。总体而言，产妇 GBS 定植率为 24-1%（95% CI 23-1-25-2；6514 人中有 1572 人）；马里最高（41-1% [37-7-44-6]；764 人中有 314 人），埃塞俄比亚最低（11-6% [9-5-14-1]；759 人中有 88 人）。直肠阴道 GBS 定殖的妇女垂直传播 GBS 的总比例为 72-3%（70-0-74-4；1566 例中的 1132 例）；莫桑比克最高（79-2% [73-3-84-2]；212 例中的 168 例），孟加拉国最低（55-8%，47-5-63-8；138 例中的 77 例）。最常见的五种 GBS 定植血清型是 Ia（37-3% [34-9-39-7]；1572 例中的 586 例）、V（28-5% [26-3-30-8]；1572 例中的 448 例）、III（25-1% [23-0-27-3]；1572 例中的 394 例）、II（9-2% [7-8-10-7]；1572 例中的 144 例）和 Ib（6-5% [5-4-7-8]；1572 例中的 102 例）。血清型比例分布存在地域差异；血清 VII 型是印度第三常见的血清型（8-6% [5-3-13-7]；174 人中有 15 人），血清 VI 型主要在孟加拉国（5-8% [3-0-11-0]；138 人中有 8 人）和印度（5-7% [3-2-10-3]；174 人中有 10 人）发现：我们的研究报告显示，大多数环境中的 GBS 定植率都很高，即使在非洲国家内部也存在一定的地域差异。我们的研究结果表明，目前多价荚膜多糖 GBS 疫苗中未包括的血清型在某些地区很普遍，因此疫苗效力和许可后效力研究应评估接种疫苗对孕产妇 GBS 定植的影响，因为非疫苗血清型有可能取代疫苗血清型：比尔及梅琳达-盖茨基金会。

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Prevalence of group B Streptococcus colonisation in mother–newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study

Background

Rectovaginal group B Streptococcus (GBS) colonisation in pregnant individuals at the time of labour is a major risk factor for invasive GBS disease by age 7 days (early-onset disease). We aimed to investigate the prevalence of rectovaginal GBS colonisation at the time of labour among pregnant women and vertical transmission to their newborns across selected low-income and middle-income African and south Asian countries.

Methods

This prospective, observational study was undertaken at 11 maternity and obstetric care facilities based in Ethiopia, Kenya, Mozambique, Nigeria, Mali, South Africa, Bangladesh, India, and Bhutan. HIV-negative pregnant women aged 18–45 years who were in the early stages of labour and at least 37 weeks’ gestation were eligible for inclusion. Lower vaginal and rectal swabs and urine were collected from the women, and swabs of the umbilicus, outer ear, axillary fold, rectum, and throat were obtained from their newborns, for GBS culture. Standardised sampling and culture using direct plating and selective media broth for detection of GBS colonisation was undertaken at the sites. Serotyping of GBS isolates was done in South Africa. The primary outcome was the prevalence of rectovaginal GBS among pregnant women, analysed in participants with available data. This study is registered with the South African National Clinical Trials Register, number DOH-27–0418–4989.

Findings

6922 pregnant women were enrolled from Jan 10, 2016, to Dec 11, 2018, of whom 6514 (94·1%; 759–892 per country) were included in the analysis; data from Bhutan were not included in the study due to issues with specimen collection and processing. Overall, the prevalence of maternal GBS colonisation was 24·1% (95% CI 23·1–25·2; 1572 of 6514); it was highest in Mali (41·1% [37·7–44·6]; 314 of 764) and lowest in Ethiopia (11·6% [9·5–14·1]; 88 of 759). The overall rate of vertical transmission of GBS from women with rectovaginal GBS colonisation was 72·3% (70·0–74·4; 1132 of 1566); it was highest in Mozambique (79·2% [73·3–84·2]; 168 of 212) and lowest in Bangladesh (55·8%, 47·5–63·8; 77 of 138). The five most common GBS colonising serotypes were Ia (37·3% [34·9–39·7]; 586 of 1572), V (28·5% [26·3–30·8]; 448 of 1572), III (25·1% [23·0–27·3]; 394 of 1572), II (9·2% [7·8–10·7]; 144 of 1572), and Ib (6·5% [5·4–7·8]; 102 of 1572). There was geographical variability in serotype proportion distribution; serotype VII was the third most common serotype in India (8·6% [5·3–13·7]; 15 of 174) and serotype VI was mainly identified in Bangladesh (5·8% [3·0–11·0]; eight of 138) and India (5·7% [3·2–10·3]; ten of 174).

Interpretation

Our study reported a high prevalence of GBS colonisation in most settings, with some geographical variability even within African countries. Our findings suggest that serotypes not included in current multivalent capsular-polysaccharide GBS vaccines prevail in some regions, so vaccine efficacy and post-licensure effectiveness studies should assess the effect of vaccination on maternal GBS colonisation given the potential for replacement by non-vaccine serotypes.

Funding

Bill & Melinda Gates Foundation.

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来源期刊

Lancet Microbe Multiple-

CiteScore

27.20

自引率

0.80%

发文量

278

审稿时长

6 weeks

期刊介绍： The Lancet Microbe is a gold open access journal committed to publishing content relevant to clinical microbiologists worldwide, with a focus on studies that advance clinical understanding, challenge the status quo, and advocate change in health policy.