This was the first UK GBS conference organised by Group B Strep Support. It 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.
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Click on each link below to watch the presentation, and download the transcript (and slides where available).
Sir Nicholas Soames – Welcome & introduction
Sir Nicholas Soames MP, Patron of Group B Strep Support, opened the conference by articulating the charity’s overarching 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 educate health professionals.”
Dr Alison Bedford Russell – Overview of neonatal group B Streptococcal (GBS) disease
Dr Alison Bedford Russell described how clinical presentations of group B Strep were different between early-onset and late-onset.
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.
Dr Theresa Lamagni – Epidemiology of adult and infant GBS disease in England & Wales
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.
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.
Prof Alan Cameron – UK NSC GBS screening policy and review
Prof Alan Cameron set out the UK National Screening Committee’s 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.
Dr Andrew Thomson – RCOG recommendations/ audit
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.”
Prof Androulla Efstratiou – GBS screening & lab diagnostics in UK & continental Europe
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.
Dr Gopal Rao – Introducing a GBS screening programme in a UK setting: Northwick Park Hospital
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.
Mrs Grace Nartey – The Midwife Experience
Mrs Grace Nartey spoke of how the screening programme had been first implemented in the hospital’s antenatal clinics then extended into the community.
Dr Richard Nicholl – Neonatal unit experience
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 Reshmi Raychaudhuri – Impact on congenital pneumonia in neonates
Dr Reshmi Raychaudhuri provided more background to the decision to introduce a screening programme at Northwick Park Hospital and the emerging results.
Dr Fiona McQuaid – Patient experience survey
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.
Dr Gopal Rao 2 – Has the screening programme at Northwick Park made a difference?
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.
Mrs Alison Eddy – The legal viewpoint
Mrs Alison Eddy briefed the conference on the grounds for GBS clinical negligence 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.”
Prof Tracy Roberts – Cost-benefit analyses
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.
Afternoon panel discussion of controversies in GBS prevention – chaired by Prof Cathy Warwick
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.
Questions of the afternoon speakers – chaired by Prof Cathy Warwick
The speakers answered questions surrounding various issues such as the difficulties in informing parents about group B Strep and the choices parents have.
Summing up and close – Prof Cathy Warwick
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’.