Published online May 8, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. e1139-e1145 (doi:10.1542/peds.2005-2481)

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Incidence and Clinical Presentation of Invasive Neonatal Group B Streptococcal Infections in Germany

Kirsten Fluegge, MD^a, Anette Siedler, PhD^b, Beate Heinrich^c, Juergen Schulte-Moenting, MD^d, Maria-Jantje Moennig^e, Dorothee B. Bartels, PhD^e, Olaf Dammann, MD^e,f, Ruediger von Kries, MD^g, Reinhard Berner, MD^a for the German Pediatric Surveillance Unit Study Group

^a Department of Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
^b Robert Koch Institute, Berlin, Germany
^c German Pediatric Surveillance Unit Office, University Children's Hospital, Düsseldorf, Germany
^d Department of Biometry and Medical Statistics, University of Freiburg, Freiburg, Germany
^e Perinatal Infectious Disease Epidemiology Unit, Departments of Obstetrics and Pediatrics, Hannover Medical School, Hannover, Germany
^f Neuroepidemiology Unit, Department of Neurology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
^g Institute for Social Pediatrics and Adolescent Medicine, Ludwig Maxilimilians University, Munich, Germany

OBJECTIVE. Streptococcus agalactiae (group B Streptococcus) is an important cause of morbidity and mortality in newborn infants. So far, there have been no published data on the incidence, morbidity, and mortality of invasive neonatal group B Streptococcus infections in Germany.

METHODS. A prospective active surveillance study involving all of the pediatric hospitals, which reported their cases to the German Pediatric Surveillance Unit, and all of the microbiological laboratories serving pediatric hospitals, which reported their cases to the Laboratory Sentinel Group at Robert Koch Institute Berlin, was conducted between 2001 and 2003. Capture-recapture analysis was used to evaluate the completeness of reported neonatal invasive group B Streptococcus infections.

RESULTS. We collected and analyzed data from 347 and 360 infants with invasive group B Streptococcus infection during the first 3 months of life, as reported by pediatricians to the German Pediatric Surveillance Unit and microbiologists to the Robert Koch Institute Berlin, respectively. Using capture-recapture analysis, we calculated an incidence of 0.47 per 1000 live births. Nearly 60% of the infants suffered from early-onset disease, and 16% of these presented with meningitis. In contrast, 61.8% of infants with late-onset disease presented with meningitis. Prematurity was present in 22.4% of early-onset disease and 39.7% of late-onset disease cases, respectively. A high proportion of infants suffered from sequelae because of group B Streptococcus infection at the time of discharge from the hospital. Most common sequelae were hydrocephalus and cerebral seizure. Case fatality rate was 4.3%.

CONCLUSIONS. This study, which is the first to provide information on the current national incidence and morbidity of invasive group B Streptococcus infection in Germany, demonstrates remarkable country-specific variation in comparison with other European countries, which gather data in a similar fashion. Therefore, the importance of country-specific prevention guidelines has to be stressed.

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Key Words: Streptococcus agalactiae • incidence • invasive • neonatal • Germany

Abbreviations: GBS—group B Streptococcus • EOD—early-onset disease • LOD—late-onset disease • CRC—capture-recapture analysis • CSF—cerebrospinal fluid • ESPED—German Pediatric Surveillance Unit • RKI—Robert Koch Institute • IAP—intrapartum antibiotic prophylaxis

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Accepted Nov 28, 2005.

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