Group B Streptococcal (GBS) meningitis

What is group B strep meningitis?

Group B strep meningitis is the swelling of the lining of the brain and spinal cord (called the meninges) caused by group B streptococcal bacteria. The bacteria infect the fluid around the brain and spinal cord called cerebrospinal fluid or CSF.

Group B strep bacteria are sometimes referred to as:

GBS
Strep B
Group B streptococcus (singular)
Group B streptococci (plural)
Or by the scientific name Streptococcus agalactiae

Group B strep is a common cause of meningitis in newborns and infants worldwide. Around the world, an infant gets group B strep meningitis every 5 minutes. Sadly, every half hour, a baby dies.

Newborns and infants are the highest risk group for group B strep meningitis. Prompt treatment is key to making a good recovery so is important to know the symptoms in babies.

Group B strep meningitis in older children and adults is very rare. Older people with group B strep infections have a higher risk of urinary tract infections, lung infection (also known as pneumonia), blood infections (known as sepsis), or skin infections. 

Why is group B strep a concern if you are pregnant?

Group B strep bacteria naturally live in the bottom (rectum) or vagina of 20% to 40% of adults. We call these adults carriers. Group B strep bacteria are usually carried harmlessly and most people don’t know they are there.

But carrying group b strep in pregnancy means:

When you give birth, there is a small chance of your baby getting infected with the bacteria and becoming unwell with meningitis, sepsis or pneumonia (around 1-2 out of every 100 pregnancies)
There is a slight chance the bacteria could travel to your womb and cause a miscarriage or early labour

If you have concerns about group B strep in pregnancy, it is a good idea to discuss the risks with your midwife. Group B Strep Support also have information tailored for people in the UK and Ireland.

How do you get group B strep meningitis?

Newborns and infants have the highest risk of developing group B strep meningitis because:

During labour they can become exposed to the bacteria
They have underdeveloped immune systems which makes them more vulnerable to infections

An infection with group B strep in the first six days of life is known as an early onset infection:

60 – 70% of group B strep infections are early onset
They most likely develop after being exposed to the bacteria in the birth canal during labour
They usually result in sepsis, but around 1 in 10 are meningitis

An infection with group B strep in the first seven to 90 days of life is known as a late onset infection:

These infections develop following exposure to the bacteria after birth
Around 40% of late onset cases are meningitis.

How is group B strep meningitis treated?

Doctors must always treat meningitis caused by group B strep with antibiotics.

Prompt recognition and hospital treatment offer the best chance of a good recovery so it is important to know the symptoms in babies and seek urgent medical help if you are worried.

If group B strep meningitis is suspected in hospital, the doctor will examine your baby and take blood for tests. They might also perform a lumbar puncture. A lumbar puncture is the procedure used to collect a sample of cerebrospinal fluid (CSF). It is needed to confirm the diagnosis of meningitis.

The doctors will test the blood and CSF samples to:

Show which germ is causing the illness
Select the most appropriate antibiotics to treat the infection

The WHO have produced guidelines to help manage children with serious bacterial infections.

Many countries have guidelines from experts on how to recognise, diagnose, treat, and care for meningitis patients.

Doctors in the UK follow guidelines from NICE. These guidelines help prevent and treat infections in newborns.

Recovery from group B strep meningitis

Many babies recover well from group b strep meningitis, with no long-term impairment. But around 1 in 4 will be left with long term neurological impairmentsiv such as:

Hearing loss and tinnitus
Balance problems
Sight loss
Epilepsy
Difficulties with movement and co-ordination (ranging from muscle weakness to paralysis)
Behavioural/emotional problems
Memory/concentration problems
Learning difficulties (ranging from mild difficulties to severe disability)
Speech and language problems

These impairments might not become clear until children reach school age. Most children can do certain tasks at specific ages, even though they're all unique. If your child is not meeting milestones in their development, you should inform a doctor.

Your guide is a helpful resource for families with children recovering from meningitis in childhood.

Many people find it helps to talk to someone who has been through a similar experience. Our team are here to talk things over and provide a listening ear.

Prevention of group B strep meningitis

There are currently no vaccines available that protect against group B strep meningitis. Scientists are working on vaccines for pregnant women to protect their babies after they are born.

To prevent infection, antibiotics are given during labour if your baby is at risk of exposure.

Routine practice in countries like the USA, France, Canada, Spain, and Germany is to offer a group B strep test during pregnancy. If you have group B strep, your doctor will offer you antibiotics during labour to protect your baby. Administering antibiotics during labour can prevent early infections, but not late infections.
Other countries such as the UK and the Netherlands don't test for group b strep in pregnancy. Instead, they use risk factors to identify those at higher risk of infection. High risk mothers are then offered antibiotics in labour.

If routine testing is not available in your country you may be able to pay for a test.

If you live in the UK or Ireland, you can find out more about testing for group B strep during pregnancy on the GBS Support website.

How are MRF and CoMO helping to defeat group B strep meningitis?

MRF and CoMO are part of WHO's Technical Taskforce for the Defeating Meningitis by 2030 roadmap. This taskforce aims to have an affordable vaccine against group B strep approved for use during pregnancy by 2026.

Research we have funded has made important contributions towards achieving this goal. In the early 2000's we supported researchers to investigate proteins found on the surface of group B strep bacteria. This research later led to the identification of a vaccine candidate now included in Minervax - one of the most advanced vaccines being developed for group B strep.

Furthermore, when there is a limited amount of money for healthcare, choices need to be made about how to maximize its value. The research funded by MRF concluded that in the UK, the vaccine would be considered value for money at up to £54 per dose. By determining the value of this vaccine ahead of time, we can quickly give it to people in the Uk when the vaccine becomes licensed.