New genetic test could revolutionize scoliosis screening

Group B Strep International Awareness Month

Group B strep poses major risks for newborns
Experts want a quicker test and new procedures to protect more babies

By Dennis Thompson
HealthDay Reporter

(HealthDay News) -- For most women, a group B streptococcus infection isn't a big deal.

The bacterial infection occurs naturally in the lower intestine and vagina. And, at any given time, about one in four women are carrying group B strep with no symptoms, according to the U.S. Centers for Disease Control and Prevention.

But the moment a woman becomes pregnant, whether she's a group B strep carrier becomes a matter of extreme importance.

If she passes the infection to her child during delivery, the newborn could develop a terrible infection. Group B strep is the most common cause of sepsis and meningitis in newborns and is a frequent cause of pneumonia, according to the CDC.

"It's a potentially lethal infection, and, if it doesn't kill you, it can damage all of your organ systems, including your brain," said Dr. James McGregor, a visiting professor of clinical obstetrics and gynecology at the Keck School of Medicine at the University of Southern California. "It's a well-recognized cause of brain damage, as well as [damage to] other organs."

New screening techniques adopted by the CDC have allowed doctors to dramatically decrease the group B strep, or GBS, infection rate. Now, doctors and interest groups are asking the CDC to further revise its guidelines to include new tactics that could help reduce group B strep-related injuries and deaths even further.

"They've fallen, depending who you read, 60 to 90 percent," McGregor said. "I think the 90 percent is correct. Now we need to work on the last 10 percent."

The CDC is mulling over the guidelines even as experts and clinicians recognize International Group B Strep Awareness Month, which occurs in July.

About 21,500 cases of invasive disease and 1,700 deaths were traced to group B strep in 2005.

Current guidelines call for every pregnant woman to be screened for group B strep.

"Most of the time, we screen at the beginning of the pregnancy and at 35 or 37 weeks," said Dr. Diep Nguyen, an obstetrician/gynecologist in Manhattan Beach, Calif., and founder of the BabyKick Alliance, a nonprofit group dedicated to the prevention of stillbirths.

The screening is performed with a simple swab test. If a woman tests positive for group B strep, she is given intravenous antibiotics during labor to prevent the bacteria from infecting her child.

However, health experts cite problems with that arrangement.

For one thing, they're concerned that the needed antibiotics are not always being provided in the hustle and bustle of the delivery room.

That's why they are asking the CDC to change its guidelines so that a GBS status card would be given to all women who test positive for the bacteria. A woman would bring the card with her to the hospital, where it would remind doctors that she needs antibiotic treatment.

"That's a brilliant idea," McGregor said. "What we do now is to put a big red dot on a chart, stuff like that, but that isn't good enough. It's one more step for human error."

Experts also would like to see the CDC press for a quicker test for group B strep. The current test takes two days to culture and is useless when a woman in labor comes to the emergency department and has not been screened for GBS.

"We need a rapid test that would be like a pregnancy test, using new molecular techniques," McGregor said. "There are many circumstances in which the test wasn't done or the results aren't available."

The antibiotics themselves also pose problems. A woman needs to begin receiving the antibiotics at least four hours before delivery, but labor often proceeds too quickly for the medication to be effective. Also, some doctors worry that overuse of antibiotics will lead to strains of group B strep that are resistant to treatment.

Expectant mothers sometimes wonder why they can't just receive an antibiotic early, rather than waiting for delivery. But the reason stems from the nature of the bacteria. "As soon as you stop treating it for one week, it will come back," Nguyen said. "It occurs naturally in your gut."

The real solution, McGregor and Nguyen said, will be a group B strep vaccine that could be given to expectant mothers or, perhaps, to all women. Medical experts are pressing the CDC to help promote research for a vaccine.

"We need to have federal help for a vaccine for group B strep," McGregor said. "There are two candidate vaccines, but they're orphans because it's not an area where a vaccine manufacturer would spend a large amount of money. It's not economically feasible."

Researchers also want the CDC to caution doctors about performing invasive procedures, such as cervical examinations and membrane stripping, on pregnant women who have tested positive for group B strep. There is evidence that such procedures could press the bacteria into the vagina and even across intact membranes, potentially infecting the child in the womb.

McGregor hopes the new guidelines will help further protect babies from bacterial infection.

"Why should a 90 percent reduction be good enough when we can use our knowledge to prevent more cases?" he asked.

On the Web

To learn more about group B strep, visit the organization Group B Strep International.