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Streptococcus

Answer

The United Kingdom National Screening Committee (UK NSC) advises Ministers and the national health service in all four UK countries about all aspects of screening policy, including screening policy for group B streptococcus (GBS) carriage in pregnancy. In 2008-09 the UK NSC recommended that a national screening programme to test for GBS carriage in pregnancy using the enriched culture medium test should not be offered.

The UK NSC is currently reviewing the evidence for screening for GBS carriage in pregnancy against its criteria again. As part of the UK NSC's review the following National Institute for Health Research Health Technology Assessment (NIHR HTA) reports have been considered by the UK NSC:

Colbourn T, Asseberg C, Bojke L et al. Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost effectiveness and expected value of information analyses. Health Technol Assess (Winchester, England). 2007;11(29).

Daniels J, Gray J, Pattison H et al. Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol Assess (Winchester, England). 2009;13(42)

The UK NSC's internationally recognised criteria for appraising the viability, effectiveness and appropriateness of a screening programme states that there should be evidence from high quality randomised controlled trials (RCTs) that the screening programme is effective in reducing mortality or morbidity. The UK NSC acknowledges that undertaking RCTs is problematic in some areas and has used other types of evidence where RCTs are not feasible. However, in common with other organisations that give evidence based policy advice, the UK NSC recognise that these kinds of studies represent the gold standard.

For recommended standards of care the Royal College of Obstetricians and Gynaecologists (RCOG) published a revised Green-Top clinical guideline, on 18 July 2012, to take into account any new evidence on the prevention of early-onset neonatal GBS disease. In addition, the National Institute for Health and Clinical Excellence

(NICE) published a new guideline on antibiotics for the prevention and treatment of early-onset neonatal infection, including GBS on 22 August 2012.

National guidelines are developed to set the standards for high quality health care. In the prevention of early onset GBS disease, local maternity services should develop local guidelines (based on the RCOG's and NICE's national guideline) which all medical and midwifery staff would be expected to follow. The implementation of all guidelines should be audited regularly to confirm compliance and formulate an action plan for change in areas such as service provision education and training if the results of the audit are not satisfactory.

The United Kingdom Standards for Microbiology Investigation B 58 is for processing swabs. The B 58's use would be restricted to specific requests rather than for routine ‘checking’. In such circumstances, the laboratory may decide whether to follow the United Kingdom Standards for Microbiology Investigation B 58 or their own standard operating procedure. The United Kingdom Standards for Microbiology Investigation (BSOP58-Processing Swabs for Group B Streptococcal Carriage) provides a standardised method for culture where clinicians decide to investigate specific patients with conditions considered to confer a high risk of infection.

Data on the rates of potentially preventable early onset GBS infection is not collected. Laboratories across England, Wales and Northern Ireland submit data to the Health Protection Agency on .GBS infection. Submission of data is voluntary, therefore completeness of reporting has varied over time and across different parts of the country.

The UK NSC's review focussed its detailed assessment on screening in the United States of America as this has been documented in the literature in some detail. However, the review also includes information on GBS across the world from a systematic review published in The Lancet.

Secondary information

Type

Written question

Reference

122887; 551 cc402-4W

Session

2012-13

Subjects

Screening Streptococcus

Link

View this Written question on www.publications.parliament.uk