OPPORTUNITIES FOR PREVENTION OF PERINATAL GROUP-B STREPTOCOCCAL DISEASE - A MULTISTATE SURVEILLANCE ANALYSIS

Objective: To evaluate the potential impact of ACOG and Centers for Di sease Control and Prevention (CDC) consensus strategies for the preven tion of perinatal group B streptococcal disease. Methods: We evaluated cases of early-onset group B streptococcal disease identified by acti ve surveillance during 1995, in four areas in North America with an ag gregate 186,000 births per year. We reviewed the hospital records of m others and infants and any prenatal records available on site. Cases w ere determined to be preventable based on whether group B streptococca l screening could have been performed prenatally, sensitivity of scree ning, presence of obstetric complications, and opportunity to administ er antibiotics. Results: We reviewed records for 245 of 246 infants wi th early-onset group B streptococcal disease in the surveillance areas . Most of the 53 case-mothers who delivered preterm and 192 who delive red full-term had had at least one prenatal visit (83% and 99%, respec tively). Few case-mothers had prenatal group B streptococcal screening cultures, although compliance was high for other prenatal screening t ests. Fifty-four percent of case-mothers had a recognized obstetric ri sk factor for group B streptococcal disease: labor or rupture of membr anes at less than 37 weeks, rupture of membranes for 18 hours or longe r, or temperature 38C or greater. The estimated preventable portion of early-onset group B streptococcal cases was 78% for the screening-bas ed approach (range 74% to 82% by area), compared with 41% for the risk -based approach (range 39% to 53% by area). Conclusion: Comprehensive implementation of either of the recommended prevention strategies coul d potentially prevent a substantial proportion of early-onset group B streptococcal disease.