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.
Centers for Disease Control and Prevention:
http://www.cdc.gov/groupbstrep/about/index.html
2. 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.
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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:
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Symptoms
-- Fever
-- Difficulty feeding
-- Irritability, or lethargy (limpness or hard to wake
up the baby)
-- Difficulty breathing
-- Blue-ish color to skin
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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.
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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.)
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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.htm
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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. 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:
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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.
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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.
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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:
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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
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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.
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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:
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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
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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.
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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.
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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
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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
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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.
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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
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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
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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.
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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
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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).
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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.
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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.
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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.
35. 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.
36. 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.htm
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