GBS surveillance and prevention

Background

Group B streptococcal bacteria (GBS) are the most common cause of serious bacterial infections, such as meningitis and septicaemia, in new born babies. It is anticipated that a GBS vaccine could be available in the next decade. This vaccine, given to women during pregnancy, could protect babies from birth. Before this vaccine becomes available there are a number of questions that need to be answered including how much GBS disease there is in the UK and whether women would want to have a GBS vaccine.

The Research

Professor Heath & Dr Matthew Snape aimed to answer these questions and so prepare the UK for a future GBS vaccine. The project had two parts:

• Surveillance – this part of the project aimed to discover the current burden of GBS disease in babies under three months of age in the UK and Ireland. This data was gathered by asking paediatricians to complete a questionnaire about each new case of GBS disease they saw and also by microbiologists providing information once laboratory confirmation was available
  
• Attitudes to vaccination – this part of the project aimed to investigate the acceptability of vaccinating pregnant women. Even if a safe and effective vaccine becomes available in the UK, it cannot start saving lives unless pregnant women, and the doctors and nurses who care for them, are agreeable to vaccination

Results

The surveillance results will provide information about the current burden of GBS disease so that the potential impact of a new vaccine can be accurately measured. The study will also help to understand the attitudes of pregnant women and healthcare staff to vaccination so that when the vaccine does become available it can be implemented in the best possible way.

Progress so far

This project finished in November 2015 and we are pleased to share some of the team’s findings.

Surveillance – by asking paediatricians to notify them of cases of GBS, the research team were able to confirm there were 868 cases of GBS over 13 months. 155 of these babies had meningitis; most of these cases were late onset as they occurred after the first six days of life. These cases confirm that GBS still represents a significant health concern for young babies, despite some preventative measures that are now in place.

The research team were able to gather clinical data on many of these cases and were therefore also able to define how many of the affected babies had a known risk factor before they became ill, what antibiotics they were given, and how well they were at discharge. Finally, they were able to confirm what strains of GBS bacteria caused many of these cases and how well antibiotics worked against them.

Attitudes to vaccination – In order to gather a range of opinions the research team gathered data in three ways. Firstly they surveyed 1000 women of childbearing age. While only one third of these women had heard of GBS, 80% of this group thought they would be likely to accept a vaccine if offered as part of the UK vaccination programme.

Secondly, they undertook focus groups with pregnant women, parents of babies who had GBS, and health care works who work with pregnant women. From these groups the research team concluded that while in general pregnant women were favourable to receiving a GBS vaccine, a major awareness campaign aimed at pregnant women and health care professionals would be required.

Finally, a questionnaire was delivered across seven centres to pregnant women, maternity health care workers and neonatal doctors. These questionnaire results demonstrated a general lack of awareness of GBS among pregnant women, but a favourable attitude to vaccination, especially once information is given. The medical professionals reported a general willingness to support a GBS vaccine clinical trial. 

How this research will help us fight meningitis

By gathering accurate data on how much GBS there is in the UK the research team have provided valuable information that will inform cost effective modelling for a new vaccine and demonstrated that GBS is still a concern in the UK. This in turn will inform debates on how best to prevent it. The information gathered on GBS strains will also help researchers identify how to make a vaccine effective in the UK.

The team have also confirmed that there is a general lack of awareness of GBS but encouragingly even brief education can lead to recognition of the seriousness of this disease. and potentially to acceptance of a vaccine in pregnancy. 

When a vaccine is available for clinical trials, the research team have demonstrated that it is feasible to trial the vaccine in the UK. Their data can be used to help plan such trials, including how best to optimise recruitment and the numbers that would be required. 

Publications and posters

The following papers and posters have been published:

F McQuaid, C Jones, Z Stevens, J Plumb, R Hughes, H Bedford, PT Heath, MD Snape Attitudes towards vaccination against group B streptococcus in pregnancy Arch Dis Child 99 (7), 700-1.

F McQuaid, C Jones, Z Stevens, J Plumb, R Hughes, H Bedford, PT Heath, M Voysey, MD Snape Factors influencing women’s attitudes towards antenatal vaccines, Group B streptococcus and clinical trial participation in pregnancy: An on-line survey. BMJ Open (In press)

Fiona McQuaid, Chrissie Jones, Zoe Stevens, Helen Bedford, Jane Plumb, Carolyn Ford, Beverly Donaldson, Diane Gbesemete, Catherine O’Sullivan, Adam Finn, Stephan Hughes, Paul Heath, Matthew D Snape. Attitudes of healthcare workers towards antenatal vaccination and clinical trials of a potential GBS vaccine in pregnancy. Meningitis Research Foundation Conference, London, 2015.

Fiona McQuaid, Chrissie Jones, Zoe Stevens, Helen Bedford, Jane Plumb, Carolyn Ford, Beverly Donaldson, Diane Gbesemete, Catherine O’Sullivan, Adam Finn, Stephan Hughes, Paul Heath, Matthew D Snape. Attitudes of Pregnant women to antenatal vaccination and participation in GBS vaccine trials during pregnancy. Meningitis Research Foundation Conference, London, 2015.

F McQuaid, C Jones, Z Stevens, J Plumb, R Hughes, H Bedford, PT Heath, MD Snape Attitudes towards vaccination against Group B Streptococcus in pregnancy. Meningitis Research Foundation Conference, London, 2013.

Help support this research

This research is only made possible by the generous support of people like YOU. Help us continue by donating, or raising funds for our work. On behalf of everyone who will benefit, now and in the future, thank you.

Researchers

Prof Paul Heath, Dr Matthew Snape, Prof Androulla Efstratiou, Dr Theresa Lamagni, Dr Shamez Ladhani, Mrs Jane Plumb, Dr Rhona Hughes

Research Institution

St George’s, University of London

More information 

If you would like more information about this project, or our research in general, please contact us on research@meningitisnow.org