Authors’s names: Sana Mahtab1, Shabir A. Madhi1, Zachary J. Madewell2, Portia Mutevedzi3, Dianna M. Blau2, Cynthia G. Whitney3, Quique Bassat4,5,6,7 and for the CHAMPS Consortium

Authors’ affiliations:
1South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
2Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,
3Emory Global Health Institute, Emory University, Atlanta, Georgia, USA,
4Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique, 5ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain,
6Institutó Catalana de Recerca I Estudis Avançats [ICREA], Barcelona, Spain;
7Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain

Presenting author First name: Shabir A
Presenting author Surname : Madhi
Presenting author Affiliation: South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Presenting author: E-mail address: shabir.madhi@wits-vida.org

Abstract Themes:
1. Epidemiology and burden

Background: Invasive Group B streptococcus (GBS) is considered a common infectious cause of neonatal deaths; the contribution to stillbirths is unclear. We investigated the proportion of stillbirths and deaths in the first 90 days of life attributable to GBS, determined using post-mortem minimally invasive tissue sampling (MITS), among children in seven LMICs participating in Child Health and Mortality Prevention Surveillance (CHAMPS).
Methods: Deaths that occurred between December 2016-December 2022 were investigated with MITS. Testing included culture of blood and cerebrospinal fluid for bacteria, multi-pathogen PCR by TaqMan Array Card on blood, cerebrospinal fluid, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver, brain and placenta. Data collection included clinical record review and family interview using standardized verbal autopsy. Expert panels reviewed all information and assigned causes of death using ICD10 coding.
Results: We evaluated 3,844 deaths, including stillbirths (n=1,727), deaths in the first 24 hours (n=764), early neonatal deaths (1-<7 days; n=790) and late neonatal deaths (7-90 days; n=563). GBS was detected in post-mortem specimens in 10.7% (410/3,844) of deaths. GBS was determined to be a cause of death for 2.6% (99/3,844; range 0.2% in Sierra Leone to 7.6% in South Africa), including 2.3% (40/1,727) of stillbirths, 3.9% (30/764) in decedents within 24 hours of birth, 1.9% (15/790) of early and 2.5% (14/563) of late neonatal deaths. Among GBS-attributed deaths, 60.5% of decedents weighed <2500 grams at birth. Approximately one-third (34/99) of the deaths attributable to GBS had another concurrent pathogen attributed to being in the causal pathway to death, which included Acinetobacter baumannii (52.9%, 18/34), Escherichia coli (44.1%, 15/34), and Klebsiella pneumoniae (35.3%, 12/34).
Conclusion: Our findings confirm that GBS is an important and possibly underestimated cause of stillbirth and neonatal deaths in LMICs. These findings strengthen the call for better prevention options, including maternal vaccination for GBS in high–mortality settings.
Keywords: Streptococcus agalactiae; minimally invasive tissue sampling (MITS); stillbirths; death in 24 hours, early neonatal death (END); 7-90-day deaths.

Preferred - oral presentation