Towards a Belgian Consensus for prevention of perinatal group B streptococcal disease

Background & objectives: In Belgium, as in many other countries, group B Streptococcus (GBS) is still
the leading cause of sepsis and meningitis in neonates. In 2001, though no Belgian guidelines for their
prevention were available, in some hospitals, obstetrical programmes included a GBS prevention
policy. With an aim to reach a Belgian consensus for the prevention of perinatal group B streptococcal
disease, a national consensum meeting was organized in 2001. We report here our experience and
findings of this meeting.
Methods: In November 2001, obstetricians, neonatologists, microbiologists and infectious diseases
specialists were invited to participate in a GBS symposium. International and Belgian speakers
presented epidemiological aspects, argued comparative cost-effectiveness of different approaches for
prevention and debated technical and practical problems. Management of neonates with risk factors
for GBS disease and progress in GBS vaccines were also included in the programme. Further results
about Belgian obstetricians’ practice and compliance to a policy for prevention of neonatal GBS
diseases, as answered in two mail surveys, were commented and discussed. In an interactive session at
the end, each participant was asked to vote on the key points related to the different steps of the ideal
prevention strategy to recommend.
Results: For the main questions, 94 per cent of participants choose a screening-based approach and
94 per cent shifted from the current use of ampicillin to penicillin as first choice for antimicrobial
prophylaxis. Further, 79 per cent voted for an approach with integrated neonatal prophylaxis for
selected neonates at high risk for GBS disease and 47 per cent voted for a strategy based on an
intrapartum rapid screening-based approach.
Interpretation & conclusion: The state of the question by different speakers, the data from Belgian
epidemiology, and the debate about cost-effectiveness of different approaches led to a massive vote in
favour of the universal screening-based approach. Based on these results, a working group has been
appointed by the Ministry of Health to draft and edit Belgian recommendations for the prevention of
perinatal GBS disease.