Public Health England (PHE) does not have data on the number of babies born each year with group B streptococcus (GBS) colonisation.

PHE does have surveillance data collected from routine laboratory reporting outlining the numbers of babies less than seven days old diagnosed with GBS bacteraemia (“early onset disease”).

Data supplied in the following table are the annual counts of GBS bacteraemia in babies with early onset disease in England, Wales and Northern Ireland; 2008 to 2012

The early onset GBS bacteraemia data are published as part of the Health Protection Report series, the most recent streptococcal infection report was published in November 2013.

The chief medical officer requested the former Health Protection Agency (HPA) to explore whether a more accurate test for group B streptococcus (GBS) in pregnant women, called enriched culture medium (ECM), should be made available in its regional laboratories, when there was a clinical indication for testing.

In response to this, Public Health England (PHE, formerly the HPA) undertook a piece of work with clinical organisations to determine in which circumstances the ECM test could be used in pregnant women.

In the event, this work concluded that within current clinical guidance from the key professional bodies, UK National Screening Committee, the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence, there are no clinical indications which should prompt the offer of an ECM test for GBS and so PHE decided not to provide this test in its laboratories.

PHE does not offer any testing exclusively for GBS in babies. When a neonate presents with symptoms consistent with a systemic infection—or sepsis—isolation of micro-organisms from blood cultures remains the gold standard method of diagnosing sepsis. Neonatal sepsis can be caused by GBS, but other important micro-organisms such as E.coli and Staphylococcus aureus can also cause sepsis, and blood culture is the most effective method of differentiating between these different types of bacteria.

Public Health England (PHE) understands that enriched culture medium (ECM) testing is available for women during pregnancy in some other countries including some European countries, the United States of America and Canada.

In the United Kingdom, the 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.

At its meeting in 2012 the UK NSC recommended that in the UK context, screening for GBS carriage at 35 to 37 weeks of pregnancy should not be offered. When reviewing the evidence for antenatal screening for GBS carriage, the UK NSC looked at evidence from a number of countries. A systematic review of the global prevalence of early and late onset GBS was reviewed. This suggested that the rate of infections in the UK was comparable to that in countries and regions employing widespread testing.

Within the English context, PHE undertook a piece of work with clinical organisations, including the Royal College of Obstetricians and Gynaecologists, to determine

whether there are any circumstances in which the ECM test could be applied within current accepted standards of care.

This work by PHE concluded that there are no clinical indications for testing women for GBS using ECM methods as recommended within current guidance from the key professional bodies.

There are currently no plans to introduce, the test because within current clinical guidance from the key professional bodies, the Royal College of Obstetricians and Gynaecologists or the National Institute for Health and Care Excellence, there are no clinical indications which should prompt the offer of an enriched culture medium test for group B streptococcus.

Should the clinical guidance change the situation would be reviewed.

The chief medical officer requested the former Health Protection Agency (HPA) to make recommendations for the introduction of a more accurate test for group B streptococcus (GBS) called enriched culture medium (ECM), and make it available in its regional laboratories when there was a clinical indication for testing.

In response to this, Public Health England (PHE, formerly the HPA) undertook a piece of work with clinical organisations, including the Royal College of Obstetricians and Gynaecologists, to determine whether there are any circumstances in which the ECM test could be applied within the current standard of care.

This work by PHE concluded in December 2013 that there are no clinical indications for testing women for GBS using ECM methods as recommended within current guidance from the key professional bodies, and therefore no indications which should prompt the offer of an ECM test.

The UK National Screening Committee also recommended in 2012 that a programme of universal screening of pregnant women at 35 weeks for GBS should not be established in the United Kingdom.

PHE therefore decided not to provide this test in its laboratories.

The chief medical officer requested the former Health Protection Agency (HPA) to make recommendations for the introduction of a more accurate test for group B streptococcus (GBS) called enriched culture medium (ECM), and make it available in its regional laboratories when there was a clinical indication for testing.

In response to this, Public Health England (PHE, formerly the HPA) undertook a piece of work with clinical organisations, including the Royal College of Obstetricians and Gynaecologists, to determine whether there are any circumstances in which the ECM test could be applied within the current standard of care.

This work by PHE concluded in December 2013 that there are no clinical indications for testing women for GBS using ECM methods as recommended within current guidance from the key professional bodies, and therefore no indications which should prompt the offer of an ECM test.

The UK National Screening Committee also recommended in 2012 that a programme of universal screening of pregnant women at 35 weeks for GBS should not be established in the United Kingdom.

The current Director for Health Protection and Medical Director for Public Health England (formerly the acting chief executive of the Health Protection Agency) is content to share the reply to the letter sent to him on 21 December 2012 by the chief medical officer, Department of Health, in respect of Group B streptococcus.

A copy of the letter has been placed in the Library.

Public Health England (PHE) published a briefing note in January 2014 to provide information for PHE's regional microbiologists on the appropriate place of enriched culture medium (ECM) testing within current United Kingdom guidelines. This document was developed following discussion with other relevant professional bodies and is available on their website.

The work that led to this briefing note concluded that no indications for testing high risk women using ECM methods have been evaluated or recommended within current clinical practice. Offering the test to low risk women at 35-37 weeks of pregnancy is also not recommended in the UK.

As a result of this work, PHE decided not to introduce the test within its laboratories.

This was also mentioned in internal PHE communications in December 2013 to regional heads of microbiology operations and regional microbiology network managers.

Public Health England investigated the circumstances in which the Enriched Culture Medium (ECM) test could be used within the current guidance set out in Royal College of Obstetrics and Gynaecology guidelines on the prevention of early onset neonatal Group B Streptococcus (GBS) disease. The outcome of this work concludes that there are currently no clinical indications for the test in high risk women using ECM methods within current guidance.

Research into the use of tests for GBS carriage in high risk clinical circumstances is being considered now with the National Institute of Health Research Health Technology Assessment programme.