Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

Globally, group BStreptococcus(GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation.This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.

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Current Status of Vaccine Development for Group B Streptococcus

NeoReviews ◽

10.1542/neo.15-10-e430 ◽

2014 ◽

Vol 15 (10) ◽

pp. e430-e438 ◽

Cited By ~ 6

Author(s):

K. M. Puopolo

Keyword(s):

Vaccine Development ◽

Group B Streptococcus ◽

Current Status ◽

Group B

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Influenza vaccine programs for children in low- and middle-income countries: current status and way forward

Expert Review of Vaccines ◽

10.1080/14760584.2019.1635462 ◽

2019 ◽

Vol 18 (7) ◽

pp. 711-724 ◽

Cited By ~ 1

Author(s):

Justin R Ortiz ◽

Kathleen M Neuzil

Keyword(s):

Influenza Vaccine ◽

Current Status ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽

10.3390/nu13020681 ◽

2021 ◽

Vol 13 (2) ◽

pp. 681

Author(s):

Ritu Rana ◽

Marie McGrath ◽

Ekta Sharma ◽

Paridhi Gupta ◽

Marko Kerac

Keyword(s):

At Risk ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

World Health ◽

Cochrane Library ◽

Breastfeeding Support ◽

Middle Income ◽

Middle Income Countries ◽

Breastfeeding Practices ◽

Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

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Proton Radiotherapy Could Reduce the Risk of Fatal Second Cancers for Children with Intracranial Tumors in Low- and Middle-Income Countries

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00041.1 ◽

2021 ◽

Vol 7 (4) ◽

pp. 1-10

Author(s):

Kyle J. Gallagher ◽

Bassem Youssef ◽

Rola Georges ◽

Anita Mahajan ◽

Joelle Ann Feghali ◽

...

Keyword(s):

At Risk ◽

Proton Therapy ◽

Pediatric Patients ◽

Income Country ◽

High Income Country ◽

Intracranial Tumors ◽

Proton Radiotherapy ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Purpose To test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries. Materials and Methods We retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients' anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy ()(H0: = 1; HA: < 1). Results Proton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P < .001, α = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). Conclusion Our findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.

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Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Annals of the New York Academy of Sciences ◽

10.1111/nyas.13968 ◽

2018 ◽

Vol 1430 (1) ◽

pp. 44-79 ◽

Cited By ~ 78

Author(s):

Daniel E. Roth ◽

Steven A. Abrams ◽

John Aloia ◽

Gilles Bergeron ◽

Megan W. Bourassa ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Disease Burden ◽

Middle Income ◽

Global Prevalence ◽

Middle Income Countries ◽

Low And Middle Income

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Serotype Distribution, Population Structure, and Antimicrobial Resistance of Group B Streptococcus Strains Recovered from Colonized Pregnant Women

Journal of Clinical Microbiology ◽

10.1128/jcm.01615-16 ◽

2016 ◽

Vol 55 (2) ◽

pp. 412-422 ◽

Cited By ~ 36

Author(s):

Sarah Teatero ◽

Patricia Ferrieri ◽

Irene Martin ◽

Walter Demczuk ◽

Allison McGeer ◽

...

Keyword(s):

Population Structure ◽

Pregnant Women ◽

Antimicrobial Agents ◽

Vaccine Development ◽

Group B Streptococcus ◽

Tetracycline Resistance ◽

The United States ◽

High Rate ◽

Content Type ◽

Group B

ABSTRACTUsing serotyping, multilocus sequence typing, and whole-genome sequencing (WGS) of selected strains, we studied the population structure of 102 group BStreptococcus(GBS) isolates prospectively sampled in 2014 from vaginal/rectal swabs of healthy pregnant women in metropolitan Toronto, Canada. We also determined the susceptibilities of each of the colonizing isolates to penicillin, erythromycin, clindamycin, tetracycline, and other antimicrobial agents. Overall, we observed a high rate of tetracycline resistance (89%) among colonizing GBS isolates. We found resistance to erythromycin in 36% of the strains, and 33% were constitutively or inducibly resistant to clindamycin. The most frequently identified serotypes were III (25%), Ia (23%), and V (19%). Serotype IV accounted for 6% of the colonizing isolates, a rate consistent with that observed among patients with invasive GBS infections in metropolitan Toronto. The majority of serotype IV isolates belonged to sequence type (ST)459, a tetracycline-, erythromycin-, and clindamycin-resistant ST first identified in Minnesota, which is considered to be the main driver of serotype IV GBS expansion in North America. WGS revealed that ST459 isolates from Canada are clonally related to colonizing and invasive ST459 organisms circulating in regions of the United States. We also used WGS to study recombination in selected colonizing strains from metropolitan Toronto, which revealed multiple episodes of capsular switching. Present and future circulating GBS organisms and their genetic diversity may influence GBS vaccine development.

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