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Challenges in reducing group B Streptococcus disease in African settings
  1. Yo Nishihara1,
  2. Ziyaad Dangor2,3,4,
  3. Neil French1,5,
  4. Shabir Madhi3,4,
  5. Robert Heyderman1,6
  1. 1Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
  2. 2Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
  3. 3Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
  4. 4Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
  5. 5Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  6. 6Division of Infection and Immunity, University College London, London, UK
  1. Correspondence to Dr Yo Nishihara, Malawi-Liverpool, Wellcome Trust Clinical Research Programme, University of Malawi, College of Medicine, PO Box 30096, Chichiri, Blantyre 3, Malawi; yonishihara{at}


Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in high-income settings and is associated with high rates of neonatal mortality and morbidity. There is now increasing evidence to suggest that there is a high GBS disease burden in resource-limited countries, and it is therefore critically important to identify suitable and practical preventive strategies. In Europe and North America, intrapartum antibiotic prophylaxis (IAP) has led to a dramatic reduction of early-onset GBS disease. However, the methods for identifying pregnant women who should receive IAP and how to reduce late-onset GBS disease are not without controversy and are challenging for most sub-Saharan African countries. GBS vaccines are approaching phase III trials but are still under development. This review aims to explore the current evidence related to strategies for reducing invasive GBS disease in an African setting, the development of a GBS vaccine and whether preventative measures against GBS disease can be practically implemented.

  • group B streptococcus
  • neonatal sepsis
  • intrapartum antibiotic prophylaxis
  • GBS vaccine
  • Africa

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  • Contributors YN conceptualised and designed the article, and drafted the initial manuscript. ZD reviewed, referenced and revised the manuscript. NF, SM and RH all equally contributed to critically reviewing the manuscript. All authors approve the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Competing interests NF is in receipt of investigator-led research grants from GlaxoSmithKline. NF and RH received funding from Novartis to conduct a trial of a GBS conjugate vaccine. SAM's institution receives grant funding for work on group B streptococcus disease from Novartis and the Bill & Melinda Gates Foundation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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