BACTERIAL meningitis is a major cause of death and disability among infants in the UK. Incidence in this age group is 70 times higher than in adults and has remained unchanged over the past three decades.
The bacteria Group B Streptococcus (GBS) is currently responsible for around half of all cases of bacterial meningitis in infants under 90 days.
GBS bacteria harmlessly colonise the bowel or vagina of 20-30 per cent of women.
Newborn babies have poorly developed immune systems and if they become infected with the bacteria it can quickly spread through their body, causing severe illness.
GBS infection in an infant which occurs within seven days of birth is termed early onset and is likely to have been transmitted during birth.
Cases of early onset disease often manifest as sepsis or pneumonia. Late onset GBS infection, those occurring after seven days, are usually as a result of coming into contact with the bacteria after birth. Most of these cases manifest as meningitis.
It is a serious illness. Nearly 10 per cent of babies affected do not survive, and those who recover may have after effects such as deafness, brain damage and problems with movement and co-ordination. The fatality rate is even higher in premature babies.
Current UK guidance adopts a risk-based approach to screening pregnant women and treating with antibiotics in labour to prevent transmission of GBS bacteria to the baby.
Risk factors may include having a previous baby with GBS, premature delivery, prolonged rupture of membranes, or when the mother is feverish during delivery or ill with GBS.
However, despite the publication of UK guidelines in 2003 aimed at the prevention of early onset GBS disease, the incidence has not decreased.
The prevention of GBS infection amongst neonates is a high priority for the Meningitis Research Foundation. The introduction of routine screening of all pregnant women and antibiotic therapy in labour could substantially reduce cases of early onset disease.
We have prioritised research into prevention and are currently funding research to evaluate the potential costs and benefits of introducing a GBS vaccine.
However, although maternal vaccines are in development it will be years until we see them in widespread use.
In the interim there is room for substantial improvements in recognition, treatment and follow-up care in this vulnerable group.
We produce symptoms information for parents and are currently developing an e-learning module and algorithm for hospital management of suspected bacterial meningitis in babies less than 90 days.
Mary Millar is a member of the Meningitis Research Foundation Scotland.
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