UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Vaccines for the prevention of group B streptococcal disease

Authors
Lawrence C Paoletti, PhD
Lawrence C Madoff, MD
Carol J Baker, MD
Section Editors
Daniel J Sexton, MD
Morven S Edwards, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Group B streptococcus (GBS or Streptococcus agalactiae) is an encapsulated gram-positive bacterium that colonizes the human gastrointestinal and genital tracts. It causes invasive infections in three populations:

Neonates, particularly in the first few days of life, and infants up to three months of age (see "Group B streptococcal infection in neonates and young infants")

Pregnant women (see "Group B streptococcal infection in pregnant women")

Adults over the age of 65 years or those immunocompromised by underlying medical conditions (see "Group B streptococcal infections in nonpregnant adults")

GBS is the most frequent bacterial pathogen in neonates. Maternal antibody against type-specific capsular polysaccharide appears to be protective. However, many GBS-colonized pregnant women do not have sufficient antibody levels at delivery and infants born before 32 weeks of gestation do not benefit from optimal placental transport of available maternal IgG. Although intrapartum (IP) penicillin G or ampicillin four or more hours before delivery can prevent GBS infections in most neonates younger than seven days of age (early-onset disease), concern has been raised that if GBS strains emerge that are resistant to beta-lactams, rates of early-onset disease would increase to the pre-IP antibiotic prophylaxis era. Maternal intrapartum antibiotic prophylaxis also has attendant risk for allergic reactions, must be given with each pregnancy, and is invasive and expensive when compared with immunization. (See "Neonatal group B streptococcal disease: Prevention".)

                   

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Nov 24 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep 1996; 45:1.
  2. Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342:15.
  3. Schrag SJ, Zell ER, Lynfield R, et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med 2002; 347:233.
  4. Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002; 51:1.
  5. Edwards RK, Clark P, Sistrom CL, Duff P. Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens. Obstet Gynecol 2002; 100:534.
  6. McDuffie RS Jr, McGregor JA, Gibbs RS. Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcus carriage. Obstet Gynecol 1993; 82:487.
  7. Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347:240.
  8. Mohle-Boetani JC, Schuchat A, Plikaytis BD, et al. Comparison of prevention strategies for neonatal group B streptococcal infection. A population-based economic analysis. JAMA 1993; 270:1442.
  9. Lancefield RC. A SEROLOGICAL DIFFERENTIATION OF HUMAN AND OTHER GROUPS OF HEMOLYTIC STREPTOCOCCI. J Exp Med 1933; 57:571.
  10. Lancefield RC. A SEROLOGICAL DIFFERENTIATION OF SPECIFIC TYPES OF BOVINE HEMOLYTIC STREPTOCOCCI (GROUP B). J Exp Med 1934; 59:441.
  11. Lancefield RC, Hare R. THE SEROLOGICAL DIFFERENTIATION OF PATHOGENIC AND NON-PATHOGENIC STRAINS OF HEMOLYTIC STREPTOCOCCI FROM PARTURIENT WOMEN. J Exp Med 1935; 61:335.
  12. Lancefield RC. A microprecipitin-technic for classifying hemolytic streptococci, and improved methods for producing antisera. Proc Soc Exp Biol Med 1938; 38:473.
  13. Lancefield RC. Cellular antigens of group B streptococci. In: Streptococci and Streptococcal Diseases: Recognition, Understanding and Management, Wannamaker LW, Matsen JM (Eds), Academic Press, Inc, New York 1972. p.57.
  14. Kasper DL, Baker CJ, Jennings HJ. Cell structure and antigenic composition of GBS. Antibiot Chemother (1971) 1985; 35:90.
  15. Lancefield RC, McCarty M, Everly WN. Multiple mouse-protective antibodies directed against group B streptococci. Special reference to antibodies effective against protein antigens. J Exp Med 1975; 142:165.
  16. Marques MB, Kasper DL, Shroff A, et al. Functional activity of antibodies to the group B polysaccharide of group B streptococci elicited by a polysaccharide-protein conjugate vaccine. Infect Immun 1994; 62:1593.
  17. Kogan G, Uhrín D, Brisson JR, et al. Structural and immunochemical characterization of the type VIII group B Streptococcus capsular polysaccharide. J Biol Chem 1996; 271:8786.
  18. Lancefield RC. TWO SEROLOGICAL TYPES OF GROUP B HEMOLYTIC STREPTOCOCCI WITH RELATED, BUT NOT IDENTICAL, TYPE-SPECIFIC SUBSTANCES. J Exp Med 1938; 67:25.
  19. Wessels MR, Paoletti LC, Rodewald AK, et al. Stimulation of protective antibodies against type Ia and Ib group B streptococci by a type Ia polysaccharide-tetanus toxoid conjugate vaccine. Infect Immun 1993; 61:4760.
  20. Wessels MR, Rubens CE, Benedí VJ, Kasper DL. Definition of a bacterial virulence factor: sialylation of the group B streptococcal capsule. Proc Natl Acad Sci U S A 1989; 86:8983.
  21. Stålhammar-Carlemalm M, Stenberg L, Lindahl G. Protein rib: a novel group B streptococcal cell surface protein that confers protective immunity and is expressed by most strains causing invasive infections. J Exp Med 1993; 177:1593.
  22. Ferrieri P, Flores AE. Surface protein expression in group B streptococcal invasive isolates. Adv Exp Med Biol 1997; 418:635.
  23. Johnson DR, Ferrieri P. Group B streptococcal Ibc protein antigen: distribution of two determinants in wild-type strains of common serotypes. J Clin Microbiol 1984; 19:506.
  24. Flores AE, Ferrieri P. Molecular species of R-protein antigens produced by clinical isolates of group B streptococci. J Clin Microbiol 1989; 27:1050.
  25. Madoff LC, Hori S, Michel JL, et al. Phenotypic diversity in the alpha C protein of group B streptococci. Infect Immun 1991; 59:2638.
  26. Michel JL, Madoff LC, Kling DE, et al. Cloned alpha and beta C-protein antigens of group B streptococci elicit protective immunity. Infect Immun 1991; 59:2023.
  27. Lancefield RC. Antigens of group B streptococci relating mouse-protective antibodies and immunity. In: New Approaches for Inducing Natural Immunity to Pyogenic Organisms, Robbins JE (Ed), National Institutes of Health, Bethesda 1975. p.145.
  28. Madoff LC, Michel JL, Kasper DL. A monoclonal antibody identifies a protective C-protein alpha-antigen epitope in group B streptococci. Infect Immun 1991; 59:204.
  29. Madoff LC, Michel JL, Gong EW, et al. Protection of neonatal mice from group B streptococcal infection by maternal immunization with beta C protein. Infect Immun 1992; 60:4989.
  30. Yang HH, Madoff LC, Guttormsen HK, et al. Recombinant group B streptococcus Beta C protein and a variant with the deletion of its immunoglobulin A-binding site are protective mouse maternal vaccines and effective carriers in conjugate vaccines. Infect Immun 2007; 75:3455.
  31. Pannaraj PS, Kelly JK, Madoff LC, et al. Group B Streptococcus bacteremia elicits beta C protein-specific IgMand IgG in humans. J Infect Dis 2007; 195:353.
  32. Madoff LC, Michel JL, Gong EW, et al. Group B streptococci escape host immunity by deletion of tandem repeat elements of the alpha C protein. Proc Natl Acad Sci U S A 1996; 93:4131.
  33. Gravekamp C, Kasper DL, Michel JL, et al. Immunogenicity and protective efficacy of the alpha C protein of group B streptococci are inversely related to the number of repeats. Infect Immun 1997; 65:5216.
  34. Gravekamp C, Kasper DL, Paoletti LC, Madoff LC. Alpha C protein as a carrier for type III capsular polysaccharide and as a protective protein in group B streptococcal vaccines. Infect Immun 1999; 67:2491.
  35. Lindén V, Christensen KK, Christensen P. Correlation between low levels of maternal IgG antibodies to R protein and neonatal septicemia with group B streptococci carrying R protein. Int Arch Allergy Appl Immunol 1983; 71:168.
  36. Wästfelt M, Stâlhammar-Carlemalm M, Delisse AM, et al. Identification of a family of streptococcal surface proteins with extremely repetitive structure. J Biol Chem 1996; 271:18892.
  37. Lachenauer CS, Madoff LC. A protective surface protein from type V group B streptococci shares N-terminal sequence homology with the alpha C protein. Infect Immun 1996; 64:4255.
  38. Yang HH, Mascuch SJ, Madoff LC, Paoletti LC. Recombinant group B Streptococcus alpha-like protein 3 is an effective immunogen and carrier protein. Clin Vaccine Immunol 2008; 15:1035.
  39. Santi I, Maione D, Galeotti CL, et al. BibA induces opsonizing antibodies conferring in vivo protection against group B Streptococcus. J Infect Dis 2009; 200:564.
  40. Maione D, Margarit I, Rinaudo CD, et al. Identification of a universal Group B streptococcus vaccine by multiple genome screen. Science 2005; 309:148.
  41. Lauer P, Rinaudo CD, Soriani M, et al. Genome analysis reveals pili in Group B Streptococcus. Science 2005; 309:105.
  42. Margarit I, Rinaudo CD, Galeotti CL, et al. Preventing bacterial infections with pilus-based vaccines: the group B streptococcus paradigm. J Infect Dis 2009; 199:108.
  43. Johri AK, Paoletti LC, Glaser P, et al. Group B Streptococcus: global incidence and vaccine development. Nat Rev Microbiol 2006; 4:932.
  44. Baker CJ, Kasper DL. Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection. N Engl J Med 1976; 294:753.
  45. Baker CJ, Carey VJ, Rench MA, et al. Maternal antibody at delivery protects neonates from early onset group B streptococcal disease. J Infect Dis 2014; 209:781.
  46. Baker CJ, Edwards MS, Kasper DL. Immunogenicity of polysaccharides from type III, group B Streptococcus. J Clin Invest 1978; 61:1107.
  47. Baker CJ, Kasper DL. Group B streptococcal vaccines. Rev Infect Dis 1985; 7:458.
  48. Eisenstein TK, De Cueninck BJ, Resavy D, et al. Quantitative determination in human sera of vaccine-induced antibody to type-specific polysaccharides of group B streptococci using an enzyme-linked immunosorbent assay. J Infect Dis 1983; 147:847.
  49. Baker CJ, Rench MA, Edwards MS, et al. Immunization of pregnant women with a polysaccharide vaccine of group B streptococcus. N Engl J Med 1988; 319:1180.
  50. Avery OT, Goebel WF. CHEMO-IMMUNOLOGICAL STUDIES ON CONJUGATED CARBOHYDRATE-PROTEINS : V. THE IMMUNOLOGICAL SPECIFITY OF AN ANTIGEN PREPARED BY COMBINING THE CAPSULAR POLYSACCHARIDE OF TYPE III PNEUMOCOCCUS WITH FOREIGN PROTEIN. J Exp Med 1931; 54:437.
  51. Wessels MR, Paoletti LC, Kasper DL, et al. Immunogenicity in animals of a polysaccharide-protein conjugate vaccine against type III group B Streptococcus. J Clin Invest 1990; 86:1428.
  52. Lagergard T, Shiloach J, Robbins JB, Schneerson R. Synthesis and immunological properties of conjugates composed of group B streptococcus type III capsular polysaccharide covalently bound to tetanus toxoid. Infect Immun 1990; 58:687.
  53. Paoletti LC, Kasper DL, Michon F, et al. An oligosaccharide-tetanus toxoid conjugate vaccine against type III group B Streptococcus. J Biol Chem 1990; 265:18278.
  54. Paoletti LC, Wessels MR, Michon F, et al. Group B Streptococcus type II polysaccharide-tetanus toxoid conjugate vaccine. Infect Immun 1992; 60:4009.
  55. Jennings HJ, Lugowski C. Immunochemistry of groups A, B, and C meningococcal polysaccharide-tetanus toxoid conjugates. J Immunol 1981; 127:1011.
  56. Rodewald AK, Onderdonk AB, Warren HB, Kasper DL. Neonatal mouse model of group B streptococcal infection. J Infect Dis 1992; 166:635.
  57. Paoletti LC, Wessels MR, Rodewald AK, et al. Neonatal mouse protection against infection with multiple group B streptococcal (GBS) serotypes by maternal immunization with a tetravalent GBS polysaccharide-tetanus toxoid conjugate vaccine. Infect Immun 1994; 62:3236.
  58. Kasper DL, Paoletti LC, Wessels MR, et al. Immune response to type III group B streptococcal polysaccharide-tetanus toxoid conjugate vaccine. J Clin Invest 1996; 98:2308.
  59. Baker CJ, Paoletti LC, Wessels MR, et al. Safety and immunogenicity of capsular polysaccharide-tetanus toxoid conjugate vaccines for group B streptococcal types Ia and Ib. J Infect Dis 1999; 179:142.
  60. Paoletti LC, Pinel J, Rodewald AK, Kasper DL. Therapeutic potential of human antisera to group B streptococcal glycoconjugate vaccines in neonatal mice. J Infect Dis 1997; 175:1237.
  61. Baker CJ, Paoletti LC, Rench MA, et al. Use of capsular polysaccharide-tetanus toxoid conjugate vaccine for type II group B Streptococcus in healthy women. J Infect Dis 2000; 182:1129.
  62. Baker CJ, Paoletti LC, Rench MA, et al. Immune response of healthy women to 2 different group B streptococcal type V capsular polysaccharide-protein conjugate vaccines. J Infect Dis 2004; 189:1103.
  63. Baker CJ, Rench MA, Paoletti LC, Edwards MS. Dose-response to type V group B streptococcal polysaccharide-tetanus toxoid conjugate vaccine in healthy adults. Vaccine 2007; 25:55.
  64. Palazzi DL, Rench MA, Edwards MS, Baker CJ. Use of type V group B streptococcal conjugate vaccine in adults 65-85 years old. J Infect Dis 2004; 190:558.
  65. Baker CJ, Rench MA, Fernandez M, et al. Safety and immunogenicity of a bivalent group B streptococcal conjugate vaccine for serotypes II and III. J Infect Dis 2003; 188:66.
  66. Schutze MP, Leclerc C, Jolivet M, et al. Carrier-induced epitopic suppression, a major issue for future synthetic vaccines. J Immunol 1985; 135:2319.
  67. Madoff LC, Paoletti LC, Tai JY, Kasper DL. Maternal immunization of mice with group B streptococcal type III polysaccharide-beta C protein conjugate elicits protective antibody to multiple serotypes. J Clin Invest 1994; 94:286.
  68. Cheng Q, Carlson B, Pillai S, et al. Antibody against surface-bound C5a peptidase is opsonic and initiates macrophage killing of group B streptococci. Infect Immun 2001; 69:2302.
  69. Brodeur BR, Boyer M, Charlebois I, et al. Identification of group B streptococcal Sip protein, which elicits cross-protective immunity. Infect Immun 2000; 68:5610.
  70. Rioux S, Martin D, Ackermann HW, et al. Localization of surface immunogenic protein on group B streptococcus. Infect Immun 2001; 69:5162.
  71. Seepersaud R, Hanniffy SB, Mayne P, et al. Characterization of a novel leucine-rich repeat protein antigen from group B streptococci that elicits protective immunity. Infect Immun 2005; 73:1671.
  72. Martins ER, Andreu A, Melo-Cristino J, Ramirez M. Distribution of pilus islands in Streptococcus agalactiae that cause human infections: insights into evolution and implication for vaccine development. Clin Vaccine Immunol 2013; 20:313.
  73. Wessels MR, Kasper DL, Johnson KD, Harrison LH. Antibody responses in invasive group B streptococcal infection in adults. J Infect Dis 1998; 178:569.
  74. Amaya RA, Baker CJ, Keitel WA, Edwards MS. Healthy elderly people lack neutrophil-mediated functional activity to type V group B Streptococcus. J Am Geriatr Soc 2004; 52:46.