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Name / organisation - Group B Strep Support

Name / organisation - Group B Strep Support

and psychological harm

and psychological harm (caused by the test, diagnostic procedures and treatment) P63-64 Summary P6-8 5. The benefit from the screening programme should outweigh the physical and psychological harm (caused by the test, diagnostic procedures and treatment) P63-64 Summary P6-8 Risk of anaphylaxis as a result of antibiotics given in labour against early-onset group B Strep infection Evidence of the on-going benefit of screening in continued reduced rates of early-onset group B Strep infection in other countries would be more accurately targeted to women actually carrying group B Strep at the time, would prevent more EOGBS infections and would minimise antibiotic use in women not carrying GBS. Anaphylactic shock is very serious but extremely rare - EOGBS infection is both more common and more easily preventable. As for the issue of antibiotic resistance (see above), similar percentages of women would be offered antibiotics in labour through either a risk based or screening prevention strategy, so the issue of anaphylaxis is of equal concern with each strategy. However, a screening strategy would prevent more EOGBS infections, target antibiotics at women most likely to be carrying GBS at the time of delivery and mean fewer women not carrying GBS being given antibiotics inappropriately. Again, experience from other countries shows the risk to be extremely small xix . The review states there has been little new evidence on the effectiveness of screening at preventing EOGBS infection. However in countries that do screen and have data from before and after the introduction of screening, their incidence has dropped by up to 86% v,vivii,viii and has remained low xx . This is new evidence, showing continued benefit. The review fails to make a case why the UK should not see a similar drop in incidence were screening introduced; we can

Studies on the accuracy of the ‘gold standard’ ECM test should keep to those where the correct procedures were followed. see every reason why it should and no reason why it shouldn’t. The review focuses heavily on the accuracy of the ‘gold standard’ enriched culture medium (ECM) test, but majors on studies where it has been implemented poorly, with recommended procedures not followed. Even in those cases where the ECM test is poorly done, it is still more accurate than the standard NHS test would be. When procedures are correctly followed, a positive ECM test result is 87% predictive of whether a woman will still be carrying GBS (and a negative ECM test result is 96% predictive of her still not carrying GBS) when done within 5 weeks of delivery. xxi Countries which have implemented screening have seen their incidence of EOGBS infection fall dramatically v, vi vii,viii , whilst in the UK, where a risk based strategy is used, the incidence has increased. This suggests that screening using the ECM test is enormously effective at reducing the burden of EOGBS infection even when sometimes implemented poorly. Please return to Adrian Byrtus, UK NSC Team Administrator (on behalf of John Marshall, Projects and Programmes Manager): Adrian.Byrtus@imperial.nhs.uk by 23 rd October 2012. i Health Protection Agency, Pyogenic & non-pyogenic streptococcal bacteraemia, England, Wales &Northern Ireland: 2003, CDR Weekly Volume 14 No 16, 16 April 2004. http://www.hpa.org.uk/cdr/archives/2004/cdr1604.pdf ii Health Protection Agency, Pyogenic &non-pyogenic streptococcal bacteraemia, England, Wales & Northern Ireland: 2010. Health Protection Report Vol. 5 No. 46, 18 Nov 2011 http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317131482001 iii Health Protection Agency, Pyogenic and non-pyogenic streptococcal bacteraemia, England, Wales & Northern Ireland: 2007. Health Protection Report 2008; 2 (47): Bacteraemia http://www.hpa.org.uk/hpr/archives/2008/hpr4708.pdf#strepbact07 iv Edwards MS, Rench MA, Haffar AA, Murphy MA, Desmond MM, Baker CJ. Long-term sequelae of group B streptococcal meningitis in infants. J Pediatr 1985; 106(5):717-722

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