October to December 2006

 

GBS: Out of sight, outrageous infant killer

For anyone who has been through the experience, or seen someone else go through it, there is no doubt that childbirth is a life-changing event.  Unfortunately, as wonderful and joyful experience as it is for many, it can also be a difficult period, bringing with it new problems as well as the potential suffering.  In the most extreme cases the baby, or the mother, or both, may die (Risking Death to Give Life: World Health Organization 2006).

ON OCTOBER 7, 2006, this omen came real for twenty-three year-old mother Janice de la Cruz, and to the mothers of three other newborn babies.  Alive only for two days, the infants didn’t survive the fatal onslaught of ravenous micro-monsters more known for the innocent-sounding initials GBS (Group B Streptococci).

GBS is a species of bacteria/microorganisms that cause early and late-onset neonatal sepsis, a fatal bacterial infection in an infant.

Early onset neonatal sepsis occurs during the first seven days of life and is due to bacterial infection during labor or birth (vertical transmission).  Late-onset neonatal sepsis affects the newborn from one to seven weeks of age and is due to both vertical and horizontal transmission otherwise known as nosocomial, or infection that originates from hospital surroundings and equipment.

Under normal condition, GBS can form part of the normal human flora.  The normal human flora is a wide variety of unseen organisms (bacteria/viruses) living “commensally” with humans, essentially adapting to the environment of human body parts or organs avoiding unhealthy and life threatening effects.

The body parts or organs in which these unseen life forms live are solid organs (heart, lungs, liver, etc.), fluids (blood, cerebrospinal fluid, urine), and the lower respiratory tract.
The sterility of the human organs from these microbes is due to the inherent human body action known as mucociliary escalator that sweeps foreign matter back out of the lungs knocking down these microbes in a dormant or latent state, thus forming latent infection.  GBS is among these numerous microbes.

People “colonized” with GBS carry the bacteria in their bodies and do not develop infections and diseases.  GBS particularly thrives in the gastrointestinal tract, genital tract, and urinary tract.  Ten to 30 percent of pregnant women are harmlessly colonized with GBS.
However, exposure of the human host to some stresses agitates these microbes to re-activate, GBS included, rousing as opportunistic pathogens causing severe and fatal diseases, like sepsis.

According to the Directors of Health Promotion and Education (DHPE) based in Washington DC, male or female adults stricken with illnesses that weaken their immune system such as diabetes or cancer are in great risk of activating latent GBS.

 As to pregnant women, the 1996 publication of the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the US Center for Disease Control enumerate other important factors that could stir up GBS microbes into opportunistic pathogens that could eventually be transmitted to the child being born resulting to sepsis.  These factors include:

In a three-year research (1996—1999) conducted by the Connecticut Department of Public Health and published in the Journal of American Academy of Pediatrics 2000, GBS ranks first among 23 other species of microbes tested to cause early onset neonatal sepsis.
Data from another 10-year research conducted in Brazil (1991–2000) show that the worldwide incidence of early onset sepsis is around .7 to 3.7 cases per 1,000 newborn, while incidence of late-onset sepsis is only about .5 to 1.8 per 1,000 newborn.
US data also show that since 1970, GBS is one of the leading bacterial infection resulting to illnesses and deaths in the world, which doubled in the 1980s and continues to rise in this century.

These researches only show that the incidence of GBS infection causing  early onset sepsis acquired through vertical transmission or from mothers to newborns, is greater than late-onset sepsis acquired through nosocomial transmission or from hospital surroundings and equipment.

Other studies indicate that GBS vertical transmission with associated deaths from early onset sepsis ranges from 29% to 85%, with an average of 51%.  The data were dependent on variables like presence of GBS in mother’s vaginal tract, race, origin, age, and socio-economic class.

Some truths may creep around the Department of Health’s pronouncement exonerating medical officials of Rizal Medical Center on the supposed neglect that led to the fatal outbreak resulting to seven newborn deaths in one week’s time, with an increase of 24 deaths or from 45 in 2005 to 69 in 2006 covering the same 10-month period.

The DOH Fact Finding Committee, and National Epidemiological Center (FFC/NEC) said “hospital factors that can explain this occurrence is remote” amidst uproars linking the outbreak to unsanitary delivery rooms and unhealthy conditions at the recovery and nursery quarters.  This means investigation results were unable to link contaminated hospital equipment to the outbreak.

The reported 12 cases of newborn sepsis with seven deaths in Rizal Medical Center in Pasig last October 2006 could have been prevented had the mothers, including de la Cruz, took certain antibiotics prescribed by attending doctors during labor or during rupture of the amnion sac.  However, some experts said there is no assurance that this would totally prevent GBS transmission to the newborn.

Despite this apparent “closed case” and with the low number of deaths, the DOH and other government health research agencies like the Medical Division of the National Research Council of the Philippines of the Department of Science and Technology might have to do wider research studies to reduce deaths related to invasive GBS neonatal disease.  This could include stronger public awareness programs on the etiology and entomology of GBS especially among pregnant women.

To this day, vaccine for GBS infection is unfortunately still to be developed.   STP