What does every health worker need to know about group B Strep?
They should of course know what every mother knows and more besides.
We haven't pinned down what every mother should know, but I proposed three things in my previous message:
1) GBS is common and usually harmless in adults, but it can be life‑threatening for newborns. Around 10–30% of pregnant women carry GBS without symptoms. It is part of the normal gut/vaginal microbiome and usually causes no problems for the mother. But for babies, GBS can cause sepsis, pneumonia, and meningitis, especially in the first week of life.
2) Most early-onset GBS infections can be prevented with antibiotics during labour. If a mother carries GBS, IV antibiotics given at least 4 hours before birth reduce the risk of early-onset disease by about 80%. This is why knowing your GBS status and receiving timely treatment during labour is important. However, in many countries (eg UK), universal screening is not done - only 'high-risk' mothers are screened. (I haven't yet learned whether this high-risk approach is adequate.)
3) Parents must know the warning signs of GBS infection in babies up to 3 months old.
What should every health worker know, in addition to the above. From our discussion I understand that:
Every health worker who cares for women in pregnancy, including primary health workers, midwives, obstatricians, should be aware of their national policy for screening (does every country have a policy?) and implement this. If the national policy is universal screening, every health worker should be aware and offer this to the mother. If the national policy is risk-based screening, every health worker should be aware of and be able to identify risk factors in every pregnant woman and offer screening accordingly.
Every health worker who attends a delivery should be aware of the GBS status of the mother (where available) and should be aware that procedures such as sweeping/stripping the membranes can increase risk of GBS transmission to the baby.
Every health worker should be alert to the warning signs of GBS in babies, and act with urgency if these signs present. This applies to all nurses and midwives working in the hospital or clinic where the baby was born, and all health workers who attend the infant in the following days and weeks. Additional guidance is needed for women and health workers in low-income countries where home birth is more common and often unattended by a health professional.
GBS needs to be included in all pre-service and in-service training. Evidence-informed guidance is needed in appropriate language, format and technical level for different cadres of health worker.
What guidance is available in your country?
What else should every health worker know?
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