Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study
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  • Published on:
    Findings in line with studies of whole populations
    • Philip J Steer, Emeritus Professor of Obstetrics Imperial College London
    • Other Contributors:
      • Alison R Bedford Russell, Neonatal Consultant
      • Philippa Cox, Consultant Midwife
      • Jane E Plumb, Chief Executive

    We read with interest the letter from Steele et al regarding the Northwick Park study of screening pregnant women for GBS carriage.

    While the study was not large enough to meet most of the statistical probability tests referred to by Steele et al, the results were entirely in line with studies of whole populations such as that in the United States of America, where the incidence of early onset GBS disease in neonates has fallen by more than 80% since screening was recommended. Thus, from a Bayesian perspective, the study increased the already high probability that the introduction of screening into the UK would produce a similar beneficial effect, and moreover showed that it was feasible within existing resources.

    We fully support the calls from Steele et al for more and better research on the long term effects of intrapartum antibiotic prophylaxis, and have been greatly encouraged by a letter to us on the 10th April 2017 from Philip Dunne MP (until the dissolution of Parliament, the Minister of State for Health) which states that “I have asked the National Institute of Health Research to commission a clinical trial to compare universal screening for GBS against usual risk-based care”. Such a trial would be of major importance not just in the UK but also to the international community.

    Until the results of such a trial are available, we will continue to advocate that women should be given the facts and allowed to choose for themselves the balance be...

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    Conflict of Interest:
    Prof Steer, Dr Bedford Russell and Ms Cox are all members of the Medical Advisory Panel of charity Group B Strep Support. Mrs Plumb is the Chief Executive and founder of charity Group B Strep Support
  • Published on:
    Authors' reply to Steele et al.
    • Guduru Gopal Rao, Consultant Microbiologist Northwick Park Hospital
    • Other Contributors:
      • Paul Bassett, Statistician
      • Theresa Lamagni, Senior Epidemiologist
      • Richard Nicholl, Consultant Paediatrician

    We thank Steele et al for their interest in the article. 1,2
    We agree that over ascertainment and treatment is a limitation of the currently available screening methods as they do not accurately identify which of the carriers will pass on the infection to the baby. But screening will, at least, ensure that IAP is given to most women who may pass on the infection to the baby. This is in contrast to risk based IAP where IAP is given to women who do not carry GBS and consequently cannot pass the infection to the baby. Furthermore, the potential to be effective is limited by the fact that an estimated 65% of the mothers of babies with EOGBS infection do not have risk factors. 3
    We wish to point out that we never set out to undertake a comparative trial. We implemented screening based IAP as a service improvement in response to rates of EOGBS reaching to 1.65/1000 live births in 2013, considerably higher than average for the UK. 3
    An analysis adjusting for confounding variables was not originally undertaken for three reasons. Firstly, the number of EOGBS cases was small, and thus may not be sufficient for a fully adjusted analysis. Additionally, the full patient level data was unavailable for all cases in the pre-screening period, meaning we were unable to perform an analysis with adjustments for more than one variable. Finally, whilst statistically significant due to the large sample size, differences in age and mode of birth are fairly negligible practical...

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    Conflict of Interest:
    G Gopal Rao is on the medical advisory panel of 'Group B Strep Support' , a charity.
  • Published on:
    Gaps in the evidence base
    • Robert JC Steele, Chair UK National Screening Committee
    • Other Contributors:
      • Farah Seedat, Researcher
      • Sian Taylor-Phillips, Associate Professor

    We are grateful to the authors of “Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit:
    an observational study” for publishing the results of the screening programme for GBS carriage at Northwick Park Hospital.1 The impetus behind the programme was clearly driven by concern for the health of newborn babies and enthusiasm to reduce the rate of EOGBS in the hospital’s population.

    However, the national policy on culture based screening at 35-37 weeks gestation is that this should not be offered. In large part this is informed by concern about the screening test’s inability to reliably distinguish between women whose babies would be affected by EOGBS and those whose babies would not. The consequence of this is a high rate of overdiagnosis and subsequent overtreatment. The Northwick Park experience provides an insight into this which was not brought out in the paper.

    The paper reports an EOGBS rate of 0.99 / 1000 deliveries prior to screening and a GBS carriage rate of 29% in the population. With 9098 live births in the study period 9 cases of EOGBS in approximately 2600 carriers would be expected. Screening at 35 – 37 weeks aims to identify these carriers and offer IAP to reduce the risk of EOGBS. From what is presented in the paper regarding transmission rates, and elsewhere regarding test accuracy,2,3 between 60% and 80% of these carriers would be eligible for IAP wh...

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    Conflict of Interest:
    Robert Steele is Chair of the UK National Screening Committee. The UK National Screening Committee (UK NSC) advises ministers and the NHS in the 4 UK countries about all aspects of population screening and supports implementation of screening programmes

    Farah Seedat and Sian Taylor-Phillips undertook an independent review of the evidence related to screening for Group B Streptococcus in 2016 for the UK National Screening Committee.