Group B streptococcal infections in Louisiana.

Group B streptococcus (GBS) causes multiple diseases, most of which affect neonates and the elderly. In newborns, infection can result in stillbirth, neonatal pneumonia, sepsis, meningitis, mental retardation and hearing or vision loss in children who survive infection. Group B streptococci are common inhabitants of the gastrointestinal and genitourinary tract.5 Less commonly, they colonize the pharynx. Recent literature estimates between 15 and 40% of pregnant women are carriers of GBS. Neonates can become infected with GBS by aspiration of infected amniotic fluid during gestation or during passage through the birth canal. Less commonly, an infant can acquire GBS in the community from other colonized persons, resulting in late-onset disease. The incidence of GBS disease declines dramatically after three months of age. Nevertheless, up to 10% of pediatric cases occur beyond early infancy, and many, but not all, of these are infants who were born preterm. In the 1970’s, GBS was the leading infectious cause of neonatal morbidity and mortality in the United States and was responsible for an estimated 7,500 cases per year with a fatality rate of almost 50%. In 1992, the Committee on Infectious Diseases and Committee on Fetus and Newborn of the American Academy of Pediatrics released guidelines for prevention of neonatal GBS disease through intrapartum chemoprophylaxis of selected maternal carriers. In 1996 and 2002, these guidelines were revised. Current guidelines call for universal screening of all pregnant women during the 37th week of gestation and antibiotic treatment of women found to be carriers. In older adults, GBS generally causes pneumonia that is easily treated with antibiotics. We examined national and state data to investigate the effects of changes in screening and treatment guidelines for GBS on all diseases caused by GBS. State data were obtained from three sources: the Louisiana Reportable Disease Database, Louisiana Hospital Inpatient Discharge Data (LaHIDD), and Vital Records death certificates. To compare Louisiana and the United States, we used Active Bacterial Core Surveillance (ABCs) reports issued by the Centers for Disease Control and Prevention (CDC). ABCs is conducted by state and local health departments and the CDC. ABCs was established in 1995 in four states and has since grown to include 10 sites representing 38 million persons. Each year, active laboratory and population-based