The first 10 days of my son Scott’s life were spent in the neonatal intensive care unit (NICU) at Swedish Hospital in Seattle, his tiny body hooked up to intravenous (IV) antibiotics in an attempt to control the bacterial infection that pervaded his system. The IV line began in his foot but his small veins ruptured so easily that the line had to be moved to his other foot, then his hand, and eventually to his head. Doctors continuously poked and prodded and even performed a spinal tap with a needle that seemed as large as Scott’s entire body. My wife and I—both first-time parents—couldn’t do anything other than watch and hope as he struggled to fight off a bacterial infection with the potential to cause meningitis, neurological sequelae, and even death.
He was suffering complications from group B Streptococcus (GBS), a bacterial infection that is common and generally benign in adults but can be deadly for infants. The bacteria can be passed from mother to baby during birth. It’s scary because the bacteria frequently cause sepsis, pneumonia, and meningitis—often within hours of being born.
We were lucky—doctors were able to promptly diagnose and treat Scott so he was able to make a full recovery—but many families in other parts of the world aren’t so lucky, especially those in low-resource countries who lack access to antibiotics, rapid diagnostics, or specialty care in a NICU.
Those 10 days showed me the powerlessness families in low-resource countries must feel when faced with medical challenges like neonatal GBS infection. In more developed regions, we’ve made some progress in the fight against GBS; the United States and much of Europe routinely screen pregnant women for the bacterium or for risk factors (though that wasn’t the case when my son was born) and administer prophylactic antibiotics during labor to prevent GBS disease. But in low-resource countries where GBS disease burden is highest, preventative measures are impractical and out of reach.
Prevention is better than cure
GBS prevention isn’t as straightforward as increasing access to early screenings and antibiotics, which are only effective against early-onset disease (the form that afflicts babies up to seven days of age). All infants—even those born healthy to mothers who don’t carry the bacterium—are vulnerable to late-onset GBS disease in the weeks or months following birth. Plus, antibiotic use is not without risk; it contributes to antibiotic-resistance and can alter a baby’s microbiome (the beneficial bacteria and microbes in a baby’s body and gut). Compromising this microbiome can contribute to health issues later in life. And, GBS may play a role in miscarriage, stillbirth, and preterm delivery—all cases where maternal antibiotic prevention is of little help.
As the proverb says, prevention is better than cure.
What we need is a vaccine
No licensed vaccines currently exist against GBS, but PATH is hoping to change that. We’re working with the Biovac Institute in South Africa, Inventprise, and other partners to develop a GBS vaccine that can be delivered to pregnant women, who would then pass on the protective antibodies to their babies and eliminate the chance of newborn infection.
A GBS vaccine has huge potential all over the world, but would be revolutionary in low-resource countries that have limited access to existing interventions. South Africa has one of the highest rates of GBS disease, with approximately 3,000 babies born annually with the disease. Of those babies, an estimated 500 won’t survive the infection, and 700 will be left with severe, lifelong disabilities. Many countries underestimate disease incidence; other countries simply don’t have impact numbers at all.
A vaccine, developed specifically with low-resource countries in mind, would provide infants around the world with access to the crucial protection they need against GBS.
After starting life in the NICU, Scott is now a healthy young adult without any memory of that experience—the GBS infection didn’t leave a lasting impact. But thousands of children worldwide never make it beyond babyhood—and even more suffer blindness, deafness, and developmental delays that serve as a daily reminder of the infection’s potential for lifelong damage.
With this project, we have an opportunity to change that.
- Mark Alderson is the director of the pneumococcal vaccine and the polyvalent meningococcal vaccine projects in the Center for Vaccine Innovation and Access at PATH.