The Past and Future of Perinatal Group B Streptococcal Disease Prevention

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Abstract
Over the past 15 years, the story of perinatal group B streptococcal (GBS) disease prevention has been one of continued challenges and surprising success. The disease emerged as a leading infectious cause of neonatal morbidity and mortality in the United States in the 1970s for reasons that remain unclear. Rates of early-onset infection (i.e., onset within the first 6 days of life) were >2 cases per 1000 live births, and case fatality rates were as high as 50% [1]. Today the picture looks very different. Case fatality rates have dropped to 6.5% in 2003, primarily because of improved supportive care of sick newborns. The incidence of disease has also dropped dramatically, to 0.3 cases per 1000 live births, exceeding the Healthy People 2010 goal [2]. How did we get to this point? What are the next steps? And how does the newly licensed GBS rapid test described in this issue of Clinical Infectious Diseases [3] suggest new avenues for prevention?