Group B streptococcal disease in infants: Progress in prevention and continued challenges

Clinics in Perinatology

Volumn 37, Issue 2, 2010, Pages 375-392

  Verani, Jennifer R ^a   Schrag, Stephanie J ^a  

^a NATIONAL CENTER FOR IMMUNIZATION AND RESPIRATORY DISEASES   (United States)

Author keywords

Infant; Meningitis; Newborn; Sepsis; Streptococcus agalactiae; Streptococcus group B

Indexed keywords

AMPICILLIN; CEFAZOLIN; CLINDAMYCIN; ERYTHROMYCIN; PENICILLIN G; STREPTOCOCCUS VACCINE; VANCOMYCIN;

ANTIBIOTIC PROPHYLAXIS; ANTIBIOTIC RESISTANCE; ANTIBIOTIC SENSITIVITY; BACTERIUM CULTURE; BLOOD CELL COUNT; BLOOD CULTURE; ESCHERICHIA COLI; FALSE NEGATIVE RESULT; FEVER; GESTATIONAL AGE; GROUP B STREPTOCOCCAL INFECTION; HUMAN; INFANT; LEUKOCYTE COUNT; MATERNAL CARE; MINIMUM INHIBITORY CONCENTRATION; NEWBORN CARE; NEWBORN SEPSIS; PERINATAL PERIOD; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; RISK FACTOR; SCREENING TEST; STREPTOCOCCUS AGALACTIAE; UNITED STATES; VERTICAL TRANSMISSION; ALGORITHM; FEMALE; MASS SCREENING; MICROBIOLOGY; NEWBORN; PREGNANCY; PREGNANCY COMPLICATIONS, INFECTIOUS; PREVENTION AND CONTROL; STREPTOCOCCAL INFECTIONS;

ALGORITHMS; ANTIBIOTIC PROPHYLAXIS; DRUG RESISTANCE, BACTERIAL; FEMALE; HUMANS; INFANT, NEWBORN; INFECTIOUS DISEASE TRANSMISSION, VERTICAL; MASS SCREENING; PREGNANCY; PREGNANCY COMPLICATIONS, INFECTIOUS; RISK FACTORS; STREPTOCOCCAL INFECTIONS; STREPTOCOCCAL VACCINES; STREPTOCOCCUS AGALACTIAE; UNITED STATES;

EID: 77953533230     PISSN: 00955108     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.clp.2010.02.002     Document Type: Review

References (115)

1. Baker C.J., Barrett F.F., Gordon R.C., et al. Suppurative meningitis due to streptococci of Lancefield group B: a study of 33 infants. J Pediatr 1973, 82(4):724-729.
2. Barton L.L., Feigin R.D., Lins R. Group B beta hemolytic streptococcal meningitis in infants. J Pediatr 1973, 82(4):719-723.
3. Franciosi R.A., Knostman J.D., Zimmerman R.A. Group B streptococcal neonatal and infant infections. J Pediatr 1973, 82(4):707-718.
4. Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998, 11(3):497-513.
5. CDC Trends in perinatal group B streptococcal disease-United States, 2000-2006. MMWR Morb Mortal Wkly Rep 2009, 58(5):109-112.
6. Jordan H.T., Farley M.M., Craig A., et al. Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis. Pediatr Infect Dis J 2008, 27(12):1057-1064.
7. Baker C.J., Barrett F.F. Transmission of group B streptococci among parturient women and their neonates. J Pediatr 1973, 83(6):919-925.
8. Desa D.J., Trevenen C.L. Intrauterine infections with group B beta-haemolytic streptococci. Br J Obstet Gynaecol 1984, 91(3):237-239.
9. Katz V., Bowes W.A. Perinatal group B streptococcal infections across intact amniotic membranes. J Reprod Med 1988, 33(5):445-449.
10. Dillon H.C., Khare S., Gray B.M. Group B streptococcal carriage and disease: a 6-year prospective study. J Pediatr 1987, 110(1):31-36.
11. Easmon C.S., Hastings M.J., Clare A.J., et al. Nosocomial transmission of group B streptococci. Br Med J 1981, 283(6289):459-461.
12. Anthony B.F., Okada D.M., Hobel C.J. Epidemiology of the group B streptococcus: maternal and nosocomial sources for infant acquisitions. J Pediatr 1979, 95(3):431-436.
13. Olver W.J., Bond D.W., Boswell T.C., et al. Neonatal group B streptococcal disease associated with infected breast milk. Arch Dis Child 2000, 83(1):F48-F49.
14. Dinger J., Muller D., Pargac N., et al. Breast milk transmission of group B streptococcal infection. Pediatr Infect Dis J 2002, 21(6):567-568.
15. Godambe S., Shah P.S., Shah V. Breast milk as a source of late onset neonatal sepsis. Pediatr Infect Dis J 2005, 24(4):381-382.
16. Wang L.Y., Chen C.T., Liu W.H., et al. Recurrent neonatal group B streptococcal disease associated with infected breast milk. Clin Pediatr (Phila) 2007, 46(6):547-549.
17. NIH. Summary of the workshop on perinatal infections due to group B Streptococcus. J Infect Dis 1977, 136(1):137-152.
18. Phares C.R., Lynfield R., Farley M.M., et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008, 299(17):2056-2065.
19. Baker C.J., Barrett F.F. Group B streptococcal infections in infants. The importance of the various serotypes. JAMA 1974, 230(8):1158-1160.
20. Schrag S.J., Zywicki S., Farley M.M., et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000, 342(1):15-20.
21. Puopolo K.M., Madoff L.C., Eichenwald E.C. Early-onset group B streptococcal disease in the era of maternal screening. Pediatrics 2005, 115(5):1240-1246.
22. Edwards M.S., Rench M.A., Haffar A.A., et al. Long-term sequelae of group B streptococcal meningitis in infants. J Pediatr 1985, 106(5):717-722.
23. Lewin E.B., Amstey M.S. Natural history of group B streptococcus colonization and its therapy during pregnancy. Am J Obstet Gynecol 1981, 139(5):512-515.
24. Hoogkamp-Korstanje J.A., Gerards L.J., Cats B.P. Maternal carriage and neonatal acquisition of group B streptococci. J Infect Dis 1982, 145(6):800-803.
25. Hansen S.M., Uldbjerg N., Kilian M., et al. Dynamics of Streptococcus agalactiae colonization in women during and after pregnancy and in their infants. J Clin Microbiol 2004, 42(1):83-89.
26. Badri M.S., Zawaneh S., Cruz A.C., et al. Rectal colonization with group B Streptococcus: relation to vaginal colonization of pregnant women. J Infect Dis 1977, 135(2):308-312.
27. Meyn L.A., Krohn M.A., Hillier S.L. Rectal colonization by group B Streptococcus as a predictor of vaginal colonization. Am J Obstet Gynecol 2009, 201(1):76. e1-e7.
28. Schrag S., Gorwitz R., Fultz-Butts K., et al. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002, 51(RR-11):1-22.
29. Campbell J.R., Hillier S.L., Krohn M.A., et al. Group B streptococcal colonization and serotype-specific immunity in pregnant women at delivery. Obstet Gynecol 2000, 96(4):498-503.
30. Newton E.R., Butler M.C., Shain R.N. Sexual behavior and vaginal colonization by group B Streptococcus among minority women. Obstet Gynecol 1996, 88:577-582.
31. Stapleton R.D., Kahn J.M., Evans L.E., et al. Risk factors for group B streptococcal genitourinary tract colonization in pregnant women. Obstet Gynecol 2005, 106(6):1246-1252.
32. Katz V.L., Moos M.K., Cefalo R.C., et al. Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment. Am J Obstet Gynecol 1994, 170(2):521-526.
33. El Beitune P., Duarte G., Maffei C.M., et al. Group B Streptococcus carriers among HIV-1 infected pregnant women: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2006, 128(1-2):54-58.
34. Yancey M.K., Duff P., Kubilis P., et al. Risk factors for neonatal sepsis. Obstet Gynecol 1996, 87(2):188-194.
35. Regan J.A., Klebanoff M.A., Nugent R.P., et al. Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group. Am J Obstet Gynecol 1996, 174(4):1354-1360.
36. Liston T.E., Harris R.E., Foshee S., et al. Relationship of neonatal pneumonia to maternal urinary and neonatal isolates of group B streptococci. South Med J 1979, 72(11):1410-1412.
37. Wood E.G., Dillon H.C. A prospective study of group B streptococcal bacteriuria in pregnancy. Am J Obstet Gynecol 1981, 140(5):515-520.
38. Persson K., Christensen K.K., Christensen P., et al. Asymptomatic bacteriuria during pregnancy with special reference to group B streptococci. Scand J Infect Dis 1985, 17(2):195-199.
39. Boyer K.M., Gotoff S.P. Strategies for chemoprophylaxis of GBS early onset infections. Antibiot Chemother 1985, 35:267-280.
40. CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep 1996, 45(RR-7):1-24.
41. Adams W.G., Kinney J.S., Schuchat A., et al. Outbreak of early onset group B streptococcal sepsis. Pediatr Infect Dis J 1993, 12(7):565-570.
42. Boyer K.M., Gadzala C.A., Burd L.I., et al. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early onset disease. I. Epidemiologic rationale. J Infect Dis 1983, 148(5):795-801.
43. Schuchat A., Deaver-Robinson K., Plikaytis B.D., et al. Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. The Active Surveillance Study Group. Pediatr Infect Dis J 1994, 13(7):623-629.
44. Adair C.E., Kowalsky L., Quon H., et al. Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. CMAJ 2003, 169(3):198-203.
45. Schuchat A., Zywicki S.S., Dinsmoor M.J., et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics 2000, 105:21-26.
46. Schuchat A., Oxtoby M., Cochi S., et al. Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta. J Infect Dis 1990, 162(3):672-677.
47. Oddie S., Embleton N.D. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ 2002, 325(7359):308.
48. Baker C.J., Kasper D.L. Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection. N Engl J Med 1976, 294(14):753-756.
49. Van Dyke M.K., Phares C.R., Lynfield R., et al. Evaluation of universal antenatal screening for group B Streptococcus. N Engl J Med 2009, 360(25):2626-2636.
50. Baker C.J., Edwards M.S., Kasper D.L. Role of antibody to native type III polysaccharide of group B Streptococcus in infant infection. Pediatrics 1981, 68(4):544-549.
51. Vogel L.C., Boyer K.M., Gadzala C.A., et al. Prevalence of type-specific group B streptococcal antibody in pregnant women. J Pediatr 1980, 96(6):1047-1051.
52. Christensen K.K., Christensen P., Dahlander K., et al. Quantitation of serum antibodies to surface antigens of group B streptococci types Ia, Ib, and III: low antibody levels in mothers of neonatally infected infants. Scand J Infect Dis 1980, 12(2):105-110.
53. Christensen K.K., Dahlander K., Linden V., et al. Obstetrical care in future pregnancies after fetal loss in group B streptococcal septicemia. A prevention program based on bacteriological and immunological follow-up. Eur J Obstet Gynecol Reprod Biol 1981, 12(3):143-150.
54. Faxelius G., Bremme K., Kvist-Christensen K., et al. Neonatal septicemia due to group B streptococci-perinatal risk factors and outcome of subsequent pregnancies. J Perinat Med 1988, 16(5-6):423-430.
55. Carstensen H., Christensen K.K., Grennert L., et al. Early-onset neonatal group B streptococcal septicaemia in siblings. J Infect 1988, 17(3):201-204.
56. Lin F.Y., Weisman L.E., Troendle J., et al. Prematurity is the major risk factor for late-onset group B Streptococcus disease. J Infect Dis 2003, 188(2):267-271.
57. Boyer K.M., Gotoff S.P. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. New Engl J Med 1986, 314(26):1665-1669.
58. Garland S.M., Fliegner J.R. Group B Streptococcus (GBS) and neonatal infections: the case for intrapartum chemoprophylaxis. Aust N Z J Obstet Gynaecol 1991, 31(2):119-122.
59. Schrag S.J., Zell E.R., Lynfield R., et al. A population-based comparison of strategies to prevent early onset group B streptococcal disease in neonates. New Engl J Med 2002, 347(4):233-239.
60. Lin F.Y., Brenner R.A., Johnson Y.R., et al. The effectiveness of risk-based intrapartum chemoprophylaxis for the prevention of early onset neonatal group B streptococcal disease. Am J Obstet Gynecol 2001, 184(6):1204-1210.
61. Castor M.L., Whitney C.G., Como-Sabetti K., et al. Antibiotic resistance patterns in invasive group B streptococcal isolates. Infect Dis Obstet Gynecol 2008, 2008:727505.
62. Bromberger P., Lawrence J.M., Braun D., et al. The influence of intrapartum antibiotics on the clinical spectrum of early onset group B streptococcal infection in term infants. Pediatrics 2000, 106:244-250.
63. Escobar G.J., Li D.K., Armstrong M.A., et al. Neonatal sepsis workups in infants ≥2000 grams at birth: a population-based study. Pediatrics 2000, 106:256-263.
64. Pulver L.S., Hopfenbeck M.M., Young P.C., et al. Continued early onset group B streptococcal infections in the era of intrapartum prophylaxis. J Perinatol 2009, 29(1):20-25.
65. Pinto N.M., Soskolne E.I., Pearlman M.D., et al. Neonatal early onset group B streptococcal disease in the era of intrapartum chemoprophylaxis: residual problems. J Perinatol 2003, 23(4):265-271.
66. Mercer B.M., Ramsey R.D., Sibai B.M. Prenatal screening for group B Streptococcus. II. Impact of antepartum screening and prophylaxis on neonatal care. Am J Obstet Gynecol 1995, 173:842-846.
67. Peralta-Carcelen M., Fargason C.A., Cliver S.P., et al. Impact of maternal group B streptococcal screening on pediatric management in full-term newborns. Arch Pediatr Adolesc Med 1996, 150(8):802-808.
68. Balter S., Zell E.R., O'Brien K.L., et al. Impact of intrapartum antibiotics on the care and evaluation of the neonate. Pediatr Infect Dis J 2003, 22(10):853-857.
69. Glasgow T.S., Speakman M., Firth S., et al. Clinical and economic outcomes for term infants associated with increasing administration of antibiotics to their mothers. Paediatr perinat epidemiol 2007, 21(4):338-346.
70. Ascher D.P., Becker J.A., Yoder B.A., et al. Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis. J Perinatol 1993, 13(3):212-216.
71. Lieberman E., Lang J.M., Frigoletto F., et al. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 1997, 99(3):415-419.
72. de Cueto M., Sanchez M.J., Sampedro A., et al. Timing of intrapartum ampicillin and prevention of vertical transmission of group B streptococcus. Obstet gynecol 1998, 91(1):112-114.
73. Gerdes J.S., Polin R.A. Sepsis screen in neonates with evaluation of plasma fibronectin. Pediatr Infect Dis J 1987, 6(5):443-446.
74. Greenberg D.N., Yoder B.A. Changes in the differential white blood cell count in screening for group B streptococcal sepsis. Pediatr Infect Dis J 1990, 9(12):886-889.
75. Ottolini M.C., Lundgren K., Mirkinson L.J., et al. Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. Pediatr Infect Dis J 2003, 22(5):430-434.
76. Yancey M.K., Schuchat A., Brown L.K., et al. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet gynecol 1996, 88(5):811-815.
77. Lukacs S, Schuchat A, Schoendorf K. National estimates of newborn sepsis: United States, 1990-2002. Presented at the annual meeting of Society for Pediatric and Perinatal Epidemiologic Research. June 14-15, 2004, Salt Lake City (Utah).
78. McCracken G.H. Group B streptococci: the new challenge in neonatal infections. J Pediatr 1973, 82(4):703-706.
79. Freedman R.M., Ingram D.L., Gross I., et al. A half century of neonatal sepsis at Yale: 1928 to 1978. Am J Dis Child 1981, 135(2):140-144.
80. Main E.K., Slagle T. Prevention of early onset invasive neonatal group B streptococcal disease in a private hospital setting: the superiority of culture-based protocols. Am J Obstet Gynecol 2000, 182(6):1344-1354.
81. Baltimore R.S., Huie S.M., Meek J.I., et al. Early onset neonatal sepsis in the era of group B streptococcal prevention. Pediatrics 2001, 108(5):1094-1098.
82. Cordero L., Sananes M., Ayers L.W. Bloodstream infections in a neonatal intensive care unit: 12 years' experience with an antibiotic control program. Infect Control Hosp Epidemiol 1999, 20(4):242-246.
83. Angstetra D., Ferguson J., Giles W.B. Institution of universal screening for group B Streptococcus (GBS) from a risk management protocol results in reduction of early-onset GBS disease in a tertiary obstetric unit. Aust N Z J Obstet Gynaecol 2007, 47(5):378-382.
84. Sutkin G., Krohn M.A., Heine R.P., et al. Antibiotic prophylaxis and nongroup B streptococcal neonatal sepsis. Obstet Gynecol 2005, 105(3):581-586.
85. Alarcon A., Pena P., Salas S., et al. Neonatal early onset Escherichia coli sepsis: trends in incidence and antimicrobial resistance in the era of intrapartum antimicrobial prophylaxis. Pediatr Infect Dis J 2004, 23(4):295-299.
86. Rentz A.C., Samore M.H., Stoddard G.J., et al. Risk factors associated with ampicillin-resistant infection in newborns in the era of group B streptococcal prophylaxis. Arch Pediatr Adolesc Med 2004, 158(6):556-560.
87. Edwards R.K., Jamie W.E., Sterner D., et al. Intrapartum antibiotic prophylaxis and early onset neonatal sepsis patterns. Infect Dis Obstet Gynecol 2003, 11(4):221-226.
88. Isaacs D., Royle J.A. Intrapartum antibiotics and early onset neonatal sepsis caused by group B Streptococcus and by other organisms in Australia. Australasian Study Group for Neonatal Infections. Pediatr Infect Dis J 1999, 18(6):524-528.
89. Daley A.J., Isaacs D. Ten-year study on the effect of intrapartum antibiotic prophylaxis on early onset group B streptococcal and Escherichia coli neonatal sepsis in Australasia. Pediatr Infect Dis J 2004, 23(7):630-634.
90. Joseph T.A., Pyati S.P., Jacobs N. Neonatal early onset Escherichia coli disease. The effect of intrapartum ampicillin. Arch Pediatr Adolesc Med 1998, 152(1):35-40.
91. Towers C.V., Carr M.H., Padilla G., et al. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol 1998, 179(4):879-883.
92. Levine E.M., Ghai V., Barton J.J., et al. Intrapartum antibiotic prophylaxis increases the incidence of gram-negative neonatal sepsis. Infect Dis Obstet Gynecol 1999, 7(4):210-213.
93. Bizzarro M.J., Dembry L.M., Baltimore R.S., et al. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 2008, 121(4):689-696.
94. Stoll B.J., Hansen N., Fanaroff A.A., et al. Changes in pathogens causing early onset sepsis in very low birth weight infants. N Engl J Med 2002, 347(4):240-247.
95. Stoll B.J., Hansen N.I., Higgins R.D., et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J 2005, 24(7):635-639.
96. Hyde T.B., Hilger T.M., Reingold A., et al. Trends in incidence and antimicrobial resistance of early onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics 2002, 110(4):690-695.
97. Al-Hasan M.N., Lahr B.D., Eckel-Passow J.E., et al. Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007. J Antimicrob Chemother 2009, 64(1):169-174.
98. Mercer B.M., Carr T.L., Beazley D.D., et al. Antibiotic use in pregnancy and drug-resistant infant sepsis. Am J Obstet Gynecol 1999, 181(4):816-821.
99. Terrone D.A., Rinehart B.K., Einstein M.H., et al. Neonatal sepsis and death caused by resistant Escherichia coli: possible consequences of extended maternal ampicillin administration. Am J Obstet Gynecol 1999, 180:1345-1348.
100. Towers C.V., Briggs G.G. Antepartum use of antibiotics and early onset neonatal sepsis: the next 4 years. Am J Obstet Gynecol 2002, 187(2):495-500.
101. Moore M.R., Schrag S.J., Schuchat A. Effects of intrapartum antimicrobial prophylaxis for prevention of group B streptococcal disease on the incidence and ecology of early onset neonatal sepsis. Lancet Infect Dis 2003, 3(4):201-213.
102. Schrag S.J., Hadler J.L., Arnold K.E., et al. Risk factors for invasive, early onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics 2006, 118(2):570-576.
103. Kimura K., Suzuki S., Wachino J., et al. First molecular characterization of group B streptococci with reduced penicillin susceptibility. Antimicrob Agents Chemother 2008, 52(8):2890-2897.
104. Dahesh S., Hensler M.E., Van Sorge N.M., et al. Point mutation in the group B streptococcal pbp2x gene conferring decreased susceptibility to beta-lactam antibiotics. Antimicrob Agents Chemother 2008, 52(8):2915-2918.
105. Manning S.D., Foxman B., Pierson C.L., et al. Correlates of antibiotic-resistant group B streptococcus isolated from pregnant women. Obstet Gynecol 2003, 101(1):74-79.
106. Varman M., Romero J.R., Cornish N.E., et al. Characterization and mechanisms of resistance of group B streptococcal isolates obtained at a community hospital. Eur J Clin Microbiol Infect Dis 2005, 24(6):431-433.
107. Chohan L., Hollier L.M., Bishop K., et al. Patterns of antibiotic resistance among group B streptococcus isolates: 2001-2004. Infect Dis Obstet Gynecol 2006, 2006:57492.
108. Panda B., Iruretagoyena I., Stiller R., et al. Antibiotic resistance and penicillin tolerance in ano-vaginal group B streptococci. J Matern Fetal Neonatal Med 2009, 22(2):111-114.
109. Borchardt S.M., DeBusscher J.H., Tallman P.A., et al. Frequency of antimicrobial resistance among invasive and colonizing group B streptococcal isolates. BMC Infect Dis 2006, 6:57.
110. Lin F.Y., Philips J.B., Azimi P.H., et al. Level of maternal antibody required to protect neonates against early-onset disease caused by group B Streptococcus type Ia: a multicenter, seroepidemiology study. J Infect Dis 2001, 184(8):1022-1028.
111. Lin F.Y., Weisman L.E., Azimi P.H., et al. Level of maternal IgG anti-group B Streptococcus type III antibody correlated with protection of neonates against early-onset disease caused by this pathogen. J Infect Dis 2004, 190(5):928-934.
112. Baker C.J., Edwards M.S. Group B streptococcal conjugate vaccines. Arch Dis Child 2003, 88(5):375-378.
113. Heath P.T., Feldman R.G. Vaccination against group B Streptococcus. Expert Rev Vaccines 2005, 4(2):207-218.
114. Edwards M.S. Group B streptococcal conjugate vaccine: a timely concept for which the time has come. Hum Vaccin 2008, 4(6):444-448.
115. Hillier S, Ferris D, Fine D, et al. Women receiving group B Streptococcus serotype III tetanus toxoid (GBS III-TT) vaccine have reduced vaginal and rectal acquisition of GBS type III. Presented at Infectious Diseases Society of America Annual Meeting. Philadelphia, October 29 to November 1, 2009.