SHS Chan, KM Wan, WH Lee

Abstract

Group B streptococcal (GBS) infections cause significant morbidity and mortality in the newborn population of the western countries. Since 1990, the focus of group B streptococcus (GBS) disease research has shifted to prevention. Intrapartum chemoprophylaxis is well proven to be cost-effective in the prevention of early onset GBS infection. In 1996, a consensus guideline on the "Prevention of Perinatal Group B Streptococcal Disease" was published in 1996, by the collaboration of the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).1 In recent 10 years, there are enormous ongoing studies leading to new insight in epidemiology, bacteriology, treatment and different preventive strategies of GBS infection. Vaccine development has yielded encouraging result on phase I human trial, demonstrating high immunogenicity and good tolerance when monovalent vaccine was given to women of reproductive age. Development of multivalent conjugated vaccine efficacious against major serotypes causing clinical disease, will be the next goal of effective prevention that may decrease use of antibiotic prophylaxis and to offer protection to a larger population including pregnant mothers and their babies, and also to the high risk elderly. Active research comparing the "universal cultures-based" vs "risksbased" screening strategies for intrapartum chemoprophylaxis is actively ongoing. These enormous upcoming data will lead to further refinement of current consensus guidelines.

西方國家新生兒 B 族鏈球菌感染(GBS)，引起顯著的發病率和死亡率。自從 1990 年，B 族鏈球菌疾病研究的焦點已經轉移至預防。產期藥物預防治療對防止 GBS 的早期發病被証實甚具成效。1996 年，由美國婦產科學院、美國兒科學會和美國家庭醫生學會聯合發表了關於“產期 B 族鏈球菌疾病的預防”的準則。近幾年來，出現了許多新的關於 GBS 感染的流行病學、細菌學、治療和不同預防措施的新研究觀點。疫苗方面也有令人鼓舞的關於 I 期人體試驗的結果；証明給育齡期婦女單價疫苗有高的免疫反應和好的耐受性。多價聯合疫苗對引起臨床疾病的主要血清型的效果將是進一步有效預防的目標，這可以減少抗生素的預防用藥和對更大的人群包括孕婦和她們的嬰兒以及高危的老年人提供保護。對產期的藥物預防、關於“以全體的培養為基礎的”與“以高危的人群培養為基礎的”比較篩查措施正在積極進行中。這大量即將發表的資料將使當今所認同的準則更加完善。