Dear Marti and all,
'According to the WHO 2024 guideline, pregnant women should be offered universal antenatal screening for Group B Streptococcus around 35–37 weeks’ gestation. WHO also recommends a risk-based alternative in settings where universal screening is not feasible. Those who test positive should receive intravenous antibiotics, such as penicillin or ampicillin, at least four hours before delivery to prevent passing GBS to their baby. This approach reduces the risk of newborn early-onset disease risk by about 80%.' WHO Fact Sheet
Yet there is marked variation between countries. The United States and some other countries have adopted universal screening for all pregnant women. Whereas the UK (below) and others have not.
The issue is not straightforward. For example, as Kelli has eloquently said: "I wish every pregnant woman and every healthcare professional understood that a negative Group B Strep screening test does not eliminate the risk of Group B Strep disease. GBS colonization can change after screening, and while current screening and intrapartum antibiotics have saved thousands of babies’ lives, they do not prevent every case. Every newborn must still be carefully assessed, and any signs of illness should be treated with urgency because early-onset GBS disease can progress with remarkable speed."
The decision to adopt universal screening versus 'a risk-based alternative' may be complex. The typical 'risk-based alternative' is to offer intrapartum antibiotic prophylaxis when one or more risk factors are present.
https://iris.who.int/server/api/core/bitstreams/10edd56e-eb79-4782-83a2-...
In contrast to the United States, the United Kingdom does not currently have universal screening for GBS.
The National Health Service patient-facing website says:
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Group B strep is a type of bacteria called streptococcal bacteria. It's very common in both men and women and usually lives in the bottom (rectum) or vagina.
Group B strep is normally harmless and most people will not realise they have it...
Group B strep is common in pregnancy and rarely causes any problems.
It's not routinely tested for, but may be found during tests carried out for another reason, such as a urine test or vaginal swab...
Routine testing is not currently recommended and tests are rarely done on the NHS. This is because group B strep is very common and testing cannot predict whether a baby will get an infection. You can pay for a test privately...
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The NHS site does not give full information on the risk-based approach to prevention of GBS either.
The WHO guidance appears to recommend universal screening where this is feasible, and a risk-based approach where it is not. But the NHS guidance does not seem to align with WHO guidance and probably needs to be reviewed, or at least explained better.
One factor in NHS decisions is the input from NICE, the National Institute for Health and Care Excellence, which 'helps practitioners and commissioners get the best care to people, fast, while ensuring value for the taxpayer'.
I checked the NICE website and it says:
"Guidelines from the Royal College of Obstetricians and Gynaecology and The National Screening Committee do not currently recommend routine screening for GBS at any stage during pregnancy. Additionally, NICE does not currently recommend selective testing for women considered to be at increased risk of GBS."
https://www.nice.org.uk/advice/mib28/resources/xpert-gbs-test-for-the-in....
Would anyone on CHIFA have time to look into this NICE/NHS decision process a little closer on our behalf? Even better, does anyone know someone who has participated in the process? If so, please invite them to join us: www.hifa.org/joinchifa
Best wishes, Neil
CHIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org