Group B streptococcal (GBS) meningitis

On this page you’ll find an overview of meningitis caused by group B streptococcal bacteria, including symptoms, treatment and prevention.

• Group B streptococcal (GBS) meningitis is a very serious illness that can cause death and long-term disability.
• Babies under 90 days of age are at the highest risk of group B streptococcal meningitis.
• Group B streptococcal meningitis is rare in older children and adults.
• Currently there are no vaccines available that prevent group B streptococcal meningitis, but they are under development.

What is group B streptococcal meningitis?

Group B streptococcal (GBS) meningitis is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. It’s caused by the bacteria Streptococcus agalactiae, often known as group B streptococcal bacteria, group B strep bacteria or GBS bacteria.
 
Group B streptococcal meningitis occurs when the bacteria invade the body and enter the cerebrospinal fluid (CSF), which surrounds and cushions the brain and spinal cord. In the CSF, bacteria can rapidly multiply and release poisons, causing inflammation and swelling in the meninges. This increases pressure on the brain, producing symptoms of meningitis.
 
The bacteria can infect the bloodstream (causing sepsis), infect the lungs (causing pneumonia) or infect the fluid surrounding the brain and spinal cord (causing meningitis). Babies are particularly vulnerable.

What is sepsis?

• Sepsis is a life-threatening reaction to germs in the bloodstream where the body's response to an infection goes too far, causing damage to important organs and body tissues.
• Sepsis is sometimes called septicaemia or blood poisoning.
• Group B streptococcal bacteria commonly cause sepsis as well as meningitis
• Sepsis symptoms usually appear earlier than meningitis symptoms.
• Sepsis and meningitis symptoms appear the same in babies.
• It’s important to be aware of sepsis symptoms, so that life-saving treatment can be accessed fast.

What are the symptoms of group B streptococcal meningitis?

Group B streptococcal meningitis can quickly become very serious, so it’s important to know the symptoms.

Babies with group B strep disease may show the following symptoms:

• High temperature (warning: could be normal or low in babies under three months old).
• Irritability.
• Vomiting / refusing to feed.
• A high-pitched cry.
• A stiff body with jerky movements or else floppy and lifeless.
• Very sleepy / staring expression / too sleepy to wake up.
• Tense or bulging soft spot on the top of their head.
• Breathing fast / difficulty breathing.
• Extreme shivering.
• Diarrhoea (though only sometimes).
• Unusual grunting sounds.
• Blotchy skin, getting paler or turning blue.
• Pain / irritability from muscle aches or severe limb / joint pain.
• Cold hands and feet.

How do you get group B streptococcal meningitis?

Group B streptococcal meningitis can develop after exposure to the bacteria Streptococcus agalactiae.
 
Group B strep bacteria live naturally in the gut and/or vagina of around 20-40% of adults. It’s normal to have these bacteria in your body. (This is called carriage, or being ‘colonised with’ group B strep). They’re usually harmless, and most people don’t know they are there.
 
When a baby develops early-onset group B strep disease (in the first seven days of life), they’ve usually been exposed to the bacteria during labour.

Mothers of babies affected by group B strep sometimes feel responsible that they may have been the source of the infection. It’s important to remember that your baby’s group B strep infection is not your fault.
 
During pregnancy, changes to the anatomy can cause GBS bacteria to move from the gut to the vagina. Worldwide, about 15% of all pregnant women (over 20 million each year) have group B strep.⁵ Carrying these bacteria is completely harmless to pregnant women most of the time, but they can travel further into the body and infect the baby or the placenta. This can cause early birth or stillbirth.  And if a baby is exposed to the bacteria during labour, this can lead to disease.
 
Late-onset group B strep disease (between one week and three months after a baby is born) is usually caused by the bacteria being in the environment around the baby, in a hospital or in the home. A baby may get infected after being touched by someone with group B strep bacteria on their hands. 

Who can get group B streptococcal meningitis?

Babies up to three months old are at the highest risk of group B streptococcal meningitis, because their immune systems aren’t fully developed.

Your baby is at a higher risk of developing group B strep disease if:

• You’ve had a positive group B strep test result in your current pregnancy.
• Your baby is born prematurely (before 37 weeks of pregnancy).
• You had a fever (100.4 F or higher) or other signs of infection during labour.
• Your water breaks more than 24 hours before your baby is born.
• You’ve already had a baby that had a GBS infection.
• You’ve had a urinary tract infection (UTI) caused by GBS during your pregnancy.

Group B strep infection is very rare after three months of age. But it can cause disease in the elderly and in people whose immune systems are compromised, such as those with HIV or undergoing chemotherapy

How is group B streptococcal meningitis treated?

Group B streptococcal meningitis must always be treated urgently with antibiotics. 

Meningitis can kill quickly, so if your baby is showing symptoms you should seek immediate medical care. Prompt recognition and hospital treatment offer the best chance of a good recovery.

When you get to hospital the doctor may do a lumbar puncture (LP) to help diagnose meningitis. A lumbar puncture involves taking a sample of cerebrospinal fluid from the spinal canal (the space through the back bones which contains the spinal cord). A lumbar puncture is important to confirm the diagnosis of meningitis. It will also show which germ is causing the illness so doctors can choose the most appropriate treatment.

Antibiotics will be given intravenously (directly into the vein). Steroids may also be given to reduce swelling around the brain.

If your baby is very unwell, they might be transferred to a special ward in the hospital where they can be regularly monitored by hospital staff. In the UK this is known as an Intensive Care Unit.
 
Read more information about the treatment of bacterial meningitis.

What are the after-effects of group B streptococcal meningitis?

Most babies who get group B streptococcal meningitis will make a good recovery if treated quickly.

Up to half of babies who develop group B streptococcal meningitis will be left with some level of long-term disability caused by damage to the brain during the illness.

The potential after-effects include:^{6,7,8,9,10,11,12}

• Learning and intellectual disabilities such as memory loss, lack of concentration or issues with thinking and problem solving.
• Clumsiness and co-ordination problems.
• Headaches.
• Deafness, hearing problems, tinnitus, dizziness or loss of balance.
• Epilepsy or seizures.
• Weakness, paralysis or spasms.
• Speech problems.
• Loss of sight or vision problems.
• Hydrocephalus (fluid on the brain).
• Mental health issues and changes to personality or behaviour.
• Difficulties with sleep.
• Fatigue.
• Anxiety and depression.

Is there any follow-up care after recovery from group B streptococcal meningitis?

Ideally, you should be given information about what to expect during recovery before you leave the hospital. The follow-up care you receive will be different depending on where you are in the world, and the guidelines that your local doctors follow. You may have further treatment involving different teams of doctors and specialists.

In some countries (including the UK), doctors will arrange at least one follow-up appointment so they can check for longer term after-effects. This is particularly important for children, as some long-term neurodevelopmental complications can't always be identified immediately after their illness.

Read more about the follow-up care after recovery from meningitis.

Can we prevent group B streptococcal meningitis?

Most early-onset group B strep infections in babies are preventable by identifying pregnant women who are at increased risk of having a baby with a group B strep infection and treating the mother with antibiotics during labour.  

In some countries including the USA, France, Canada, Spain and Germany, it’s routine to offer women a group B strep test during pregnancy to identify mothers at increased risk. Other countries, such as the UK and the Netherlands, don’t routinely test for group B strep in pregnancy. Instead, they use risk factors to identify those at higher risk of group B strep infection.

If testing for group B strep isn’t standard practice in your country, private testing may be available, but the cost (which can vary) may not be affordable for all families.

Read more about GBS testing in the UK.

This approach to prevention has reduced the incidence of group B strep disease in babies in the first week of life, but currently, there’s no way to prevent late-onset group B strep disease (which occurs between one week and three months after a baby is born).

Can I get a vaccine to protect me against group B streptococcal meningitis?

Currently, there is no vaccine to protect against group B streptococcal meningitis.

Scientists are working to develop a vaccine that can be given to pregnant women to protect their babies during pregnancy and birth.

A vaccine could make a real difference by helping prevent:

• Stillbirths linked to GBS.
• Both early and late-onset GBS disease in newborns and young babies.
• GBS infection in mothers.
• Premature labour caused by GBS.

The World Health Organization is working to ensure that any successful GBS vaccine will be available to all countries. It does this through its prequalification programme (which makes sure vaccines are safe, work well, and made to a high standard) and by working with global partners, such as Gavi and UNICEF to ensure wide access to certain vaccines. Making GBS vaccines available to low- and middle-income countries as soon as possible is particularly important because the burden of GBS disease is highest in these countries.