2015 GBS Conference
This was the first GBS conference organised by Group B Strep Support, and was attended by 232 delegates, predominantly healthcare professionals, plus stakeholders from other key organisations and parents. It was a unique day in its inclusivity, drawing together those with a focus on neonatal group B Strep (GBS) disease prevention.
The conference opened with an excellent address by Sir Nicholas Soames MP. What followed was a journey reminding the audience how GBS manifests clinically, sharing the results of the latest surveillance study detailing incidence, GBS epidemiology, an excellent overview on GBS prevention strategies, a review of national GBS screening policy and guidelines, laboratory updates, the legal perspective, and provider and patient experiences. There was plentiful time for questions and answers within the sessions, with some vigorous and engaging discussions and debate.
Whatever the position of the variety of speakers and delegates was and is, with respect to adopting a UK GBS screening program or not, it was clear that the prevention of neonatal GBS disease is a shared goal.
You can download a free copy of the conference report or order a hard copy (small admin charge) from our shop – click here.
Click on each link below to watch the presentation, and download the transcript (and slides where available).
Sir Nicholas Soames MP, Patron of Group B Strep Support, opened the conference by articulating the charity's over-arching objective: "To reduce preventable GBS infection in babies. Save infant lives, prevent disability and prevent pain and suffering. To support and inform families affected with GBS and educated health professionals..." Sir Nicholas called on delegates to listen to the discussions closely and carefully, with an open mind. Click here to read the transcript
Dr Alison Bedford Russell described how clinical presentations of group B Strep were different between early-onset and late-onset. For example, group B Strep meningitis was more common in late-onset than early-onset GBS infection, while pneumonia was the reverse. Focal infection (infection in a particular area of the body) was "very,very rare" when it came to early-onset, and less rare for late-onset, for example, septic arthritis. Overall, generalised sepsis was the most common presentation. Dr Bedford Russell highlighted some of the difficulties of identifying early-onset GBS infection and also spoke of an increase in newborns presenting with "hypoxic ischemic encephalopathy" also [...]
Dr Catherine O’Sullivan – The burden of invasive GBS disease in young infants in the UK & Republic of Ireland 2014-2015
Dr Catherine O'Sullivan presented a comprehensive analysis of 817 cases of invasive group B Strep in infants under 90 days old, where the samples were drawn from sterile sites such as blood culture or spinal fluid. "In looking from 2014 to 2015, again preliminary, but what we have at the moment, we have an incidence of 0.89 per 1,000 live births which is an increase from 2000-2001 where it was 0.72. Also in those 14-15 years we have seen increased incidence across all countries." Click here to read the transcript Click here to view the slides [...]
Dr Theresa Lamagni focussed on the epidemiology of invasive group B Strep disease across all age groups from 1991 onwards, using data from Public Health England Laboratory reports between 1991 and 2014. There was a more in-depth focus on 2014 using this data supplemented with Hospital Episode Statistics data and NHS demographic batch tracing. Dr Lamagni observed that there had not been the hoped-for drop in the incidence of GBS disease following the Royal College of Obstetricians and Gynaecologists guidelines at the end of 2003. "The rates of early-onset and late-onset disease have not decreased since the introduction of [...]
Prof Philip Steer – GBS prevention strategies – UK & International (risk based, screening and vaccination)
Prof Philip Steer considered the two major approaches to preventing group B Strep infection in newborn babies: one based on antenatal screening and the other based on identification of risk factors during pregnancy. Identification of risk factors is the approach currently recommended by the Royal College of Obstetricians and Gynaecologists (RCOG) and in use in the UK. "The risk factor approach is very inconsistent - it's very confusing for professionals and certainly for women at large." Click here to read the transcript Click here to view the slides
Prof Alan Cameron set out the UK National Screening Committee's (NSC) current policy position on antenatal screening for GBS carriage (2012): Routine screening for GBS carriage in late pregnancy for all pregnant women is currently not recommended in the UK. There was insufficient evidence that benefits gained from screening all women in late pregnancy and treating those women with confirmed GBS carriage by intravenous antibiotics during labour outweigh harm. The next review by the National Screening Committee is due in 2015/16. "We certainly feel that more evidence is needed about the care received by women to refine [...]
Dr Andrew Thomson provided insight into the introduction of the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. He stated that the process to revise the RCOG GBS guideline is now underway, "if the evidence was compelling that we needed to change the practice, then we could revise a guideline in one year or less." "The RCOG GBS guideline initially published in 2003 and revised in 2012 concluded that routine bacteriological screening of all pregnant women for antenatal GBS carriage is not recommended. So we grade our recommendations and this is given as a grade D recommendation and [...]
Prof Neena Modi started the Q&A by asking what has been done to improve the evidence base in order to form the development of really robust guidelines. Prof Philip Steer responded that there was a need to improve the information about the impact of screening versus risk factors, but that it was highly unlikely that a screening RCT (randomised control trial) would be funded in the UK. This meant reliance on evidence from experts. This was followed by a discussion about the use of antibiotics, their potential to affect a mother's faecal flora and the potential impact on development of [...]
Prof Androulla Efstratiou spoke first about microbiological screening. Currently: Most units did not use a sensitive test to detect GBS carriage*. Risk factors recommended by RCOG to select women for antibiotics in labour were poor at predicting GBS carriage. Almost 1 in 5 women who had no known risk factors in fact carried GBS. Many GBS carriers were falsely given a negative result from a standard test. *Since the presentation, Prof Efstratiou has confirmed to us that the ECM test is not routinely available from PHE laboratories. "It is extremely important to have a very sensitive and also a Standardised [...]
Dr Gopal Rao said that before the screening programme was put in place in late February 2014, the Trust had for several years experienced substantially higher levels of invasive GBS than the national rate: Approximately 5000 babies per year are born at Northwick Park Hospital Despite using a risk based IAP protocol, the invasive EOGBS rate was 0.88/1000 live births per year over the four years (2008-2012) twice the national rate (0.4/1000 live births) In 2013, the EOGBS rate was 1.65 per thousand live births; five out of the eight affected babies did not have maternal risk factors [...]
Mrs Grace Nartey spoke of how the screening programme had been first implemented in the hospital's antenatal clinics then extended into the community. There has been complete buy-in from healthcare professionals - the clinicians, the midwives and the maternity assistants. Educating staff was important with posters and a leaflet. "It was about getting women on board and getting them to understand the reasons why we were concerned and felt that it was necessary to offer this programme." Click here to read the transcript Click here to view the slides
Dr Richard Nicholl opened by saying how struck he had been by the honesty of the previous speakers when they spoke of "inefficiencies, errors and omissions". Dr Nicholl described how those overseeing young babies could easily reach the wrong conclusions. For example, on handover each day, trainees would talk about babies on the postnatal ward "maybe not feeding well, been a bit jittery, some jaundice... and the first they [the trainees] will say every day, seven days a week is, 'there are no risk factors for sepsis'." "I should imagine it's quite difficult to be pregnant and not [...]
Dr Reshmi Raychaudhuri provided more background to the decision to introduce a screen programme at Northwick Park Hospital and the emerging results. "secondary to prematurity and its complications, congenital pneumonia and early onset sepsis are the most important causes of neonatal morbidity and mortality and we know that GBS infection is the commonest cause of early onset sepsis in neonates." Click here to read the transcript Click here to view the slideshow
Dr Fiona McQuaid reported on a self-completed paper survey distributed to 100 pregnant women between July and September 2014, roughly 4 months after screening had been introduced. Around 98% of those approached completed the survey. This yielded information across a range of issues. One notable result was that 57% of women asked said that they hadn't heard of Group B Strep before. "So, in conclusion, I think from given the limitations of this study with relatively small numbers the group B strep screening is considered to be acceptable, fairly easy test to do, maybe a little bit [...]
Dr Gopal Rao concurred with Dr Raychaudhuri's findings - although not yet statistically significant, the introduction of universal maternal GBS screening at Northwick Park Hospital had been associated with the reduction in the number of cases of infections and congenital pneumonia, with no cases of the condition identified after screening. The proportion of women screened had started at 40% and was now at 80%. Dr Rao discussed cost effectiveness in some detail, concluding overall that in the 'worst case scenario the screening programme was cost neutral.' "when I clubbed all the unscreened populations together, we had roughly [...]
Mrs Eddy briefed the conference on the grounds for such claims. In Mrs Eddy's professional experience, birth injuries were largely the result of "problems not having been spotted, or problems identified but then somebody not coming when perhaps they should have come." If litigation ensued it, was very costly, with the breaches of duty tending to follow a pattern: failure to consider infection as a possible cause of complications during pregnancy; failure to prescribe and administer antibiotics during labour or to do so for early-onset neonatal infection; and, finally, failure to recognise and treat sick babies in first [...]
Prof Tracy Roberts described economic evaluation not as absolute costs and benefits, but comparing new treatments to current practice. Prof Roberts said that a mother might be positive or negative, but what was then important was whether the interventions consequent upon the result prevented the baby from getting an infection. She discussed looked at modelling three different strategies: using risk factors to determine which women to offer antibiotics in labour to, using the 'culture test' at 35 weeks to do this, and giving routine antibiotics to all. "we need to understand what current practice is because it affects the [...]
Against a backdrop of a global crisis in antibiotic resistance, Dr Alison Bedford Russell said that antibiotics should only be given for a very clear reason, in the appropriate dose and for as short a time as possible. Resistance was everyone's problem. Giving mothers antibiotics because they might have something was simply not good enough in this era. There were other tools, PCR for example, as well as culture-based methods as alternatives. We needed to get a lot cleverer at this. Proof Neena Modi felt that everyone should be able to agree that "the current guidance is inconsistent [...]
The speakers answered questions surrounding various issues such as the difficulties in informing parents about group B Strep and the choices parents have. When discussing the information provided to mothers, Mrs Grace Nartley stated that "she’s well-informed in the screening that we offer, she’s also well-informed about the options that she has and where to give birth... as long as we are giving the information and telling what the pros and cons are from all angles, then the woman is fully informed, then she makes that choice." "in the private sector, offering screening is virtually across the board and [...]
Prof Cathy Warwick closed the day. She said the debate had been presented in a very balanced and very responsible was, although '... there was a danger that... the professions had very much fallen into two camps'. The day had shown that there was a lot of room for discussion and a lot of options for moving forward. "I’m also really interested in how confusing the situation is ... everyone’s doing different things and that just feels to me like it can’t be safe. Safety in healthcare does depend on us all understanding what each other is [...]