Increased Risk for Group B Streptococcus Sepsis in Young Infants Exposed to HIV, Soweto,

AlthoughgroupBStreptococcus�(GBS)�isaleadingcause� ofsevereinvasivediseaseinyounginfantsworldwide,�epi- demiologicdataandknowledgeaboutriskfactorsforthe� diseasearelackingfromlow-�tomiddle-incomecountries.� TodeterminetheepidemiologyofinvasiveGBSdisease� amongyounginfantsinasettingwithhighmaternalHIV� infection,�weconductedhospital-basedsurveillanceduring� 2004-2008�inSoweto,�SouthAfrica.�OverallGBSincidence� was�2.72�cases/1,000�livebirths�(1.50�and�1.22,�respective- ly,�amonginfantswithearly-onsetdisease�(EOD)�andlate- onset�(LOD)�disease).�RiskforEODandLODwashigherfor� HIV-exposedthanHIV-unexposedinfants.�GBSserotypes� IaandIIIaccountedfor�84.0%�ofcases,�and�16.9%�ofin- fectedinfantsdied.�WeestimatethatuseoftrivalentGBS� vaccine�(serotypesIa,�Ib,�andIII)�couldprevent�2,105�inva- siveGBScasesand�278�deathsannuallyamonginfantsin� SouthAfrica;�therefore,�vaccinationofallpregnantwomen� inthiscountryshouldbeexplored. Group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants. A meta-analysis dominated by studies from high-income countries estimated global incidence of 0.53 cases/1,000 live births during 2000- 2011 (3). Considerable intra- and interregional variation in the incidence of invasive early-onset disease (EOD; disease in 0- to 6-day-old infants ) was observed (3-5), ranging from 1.21 cases/1,000 live births (95% CI 0.5-1.91) in Africa to 0.02 cases/1,000 live births (95% CI 0-0.07) in Southeast Asia (3). This variability is inconsistent with the lesser dif- ference in prevalence of maternal GBS colonization, the major risk factor for EOD, in women from different regions (20.9% in Africa, 13.4% in Southeast Asia) (6). Maternal HIV infection has not been associated with a higher preva- lence of GBS colonization (7,8), except among women with