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Having worked as a labor and delivery nurse in Union City, Tn., Kelsey Coleman, 29, knew that Group B Streptococcus (GBS) is a common bacteria found in the vaginal tract that can cause potentially devastating diseases, including sepsis, pneumonia, and meningitis, in newborns during the first three months of life. Pregnant people who are carriers of GBS may pass the bacteria to their developing baby during pregnancy, labor, and delivery. About one in four pregnant women carry GBS, according to the Centers for Disease Control (CDC), and it is particularly common among African American women.
Kelsey also knew the standard of care in the United States is to test for GBS around 36 weeks into a pregnancy and to give antibiotics during labor to anyone who has tested positive to significantly reduce the risk of infection in the baby. But until she had her own children, she wasn’t aware of the gaps in this prevention strategy or how serious GBS can be.
“To be honest, I didn’t fully understand what would happen if the baby was infected,” Kelsey says. “[During my time as a nurse,] I never came across a baby that had contracted GBS.”
When Kelsey was pregnant with her first son, Colt, she tested negative for GBS twice. Because of those negative tests, she delivered Colt in August of 2018 without the antibiotics given to mothers who are known GBS carriers.
Colt initially seemed healthy, but he grew irritable, and Kelsey’s intuition as a mother and nurse told her something wasn’t right. “There was just this nagging feeling,” she remembers. “I was like, ‘Something’s happening. I don’t know what it is, but something’s wrong.’”
She decided to stay at the hospital the day after giving birth. By that evening, Colt had his first seizure. Hours later, he had another, and doctors told Kelsey he needed to be flown to a hospital with a neonatal intensive care unit (NICU).
“I remember crying,” Kelsey says. “Our surgery team came in; I remember them all circling around me and putting their hands on me and praying.”
She and her husband rushed to the NICU. Looking at Colt there, she says, “I was not fully convinced that he was going to survive.”
They soon learned that Colt’s blood culture — a test to detect bacteria — was growing GBS.
“I was very confused because I was just trying to figure out how that could be what was growing in his blood since I had tested negative,” Kelsey says. He was diagnosed with meningitis and cerebral swelling caused by GBS at the NICU and treated for 21 days before he was stable enough to go home with his parents. GBS is a leading cause of meningitis and bloodstream infections in newborns. It can also be a factor in miscarriages, stillbirths, and preterm births.
Colt, now 5, still struggles with verbal and fine motor skills, likely due to the GBS infection, but he loves to walk, run, and play — all activities Kelsey wasn’t initially sure he’d ever be able to do.
“He thinks it’s the funniest thing to laugh and to make people laugh,” Kelsey says. “He will be in therapy, and you’ll ask him to hand you the ball, and he will intentionally grab a shoe or something that he knows is not the right thing. And he’ll look at you, and he’ll just hysterically laugh.”
Kelsey now works as a case manager because the schedule is more accommodating for her family, which includes her husband, Colt, and a 2-year-old son. She shares her family’s story regularly to help educate others about GBS and the importance of prevention.
“I really hope that there is a vaccine one day that you can get whether your [GBS] test was positive or negative,” Kelsey says. “Not very many people are affected by it, but for the people that are affected, it can be so devastating and their life can completely change.”
Exploring GBS prevention strategies
Natalie Silmon de Monerri, who has a Ph.D. in Infection and Immunity and is an Associate Director of Microbiology at Pfizer and is the Research Scientific Lead for Pfizer’s GBS vaccine program, has been working with her team with support from the Bill and Melinda Gates Foundation to develop a potential new preventative strategy for GBS in newborns.
“We’re working on a vaccine candidate to prevent Group B Strep in babies by immunization of the pregnant mother, and the vaccine is in phase two clinical trials that are taking place in the U.S., the U.K., and South Africa,” says Natalie. The goal of the vaccine would be for the immunized mother to pass GBS-fighting antibodies to the baby through the placenta, helping to protect them from the bacteria during their first few vulnerable months of life.
“There are a lot of myths about vaccines, but they’ve been used in pregnant women for a long time now and have been shown to be very safe for both the mother and the infant and effective at preventing disease in very young infants,” Natalie notes. “Some examples of that are flu, Tdap, as well as COVID-19 vaccines. All of these are recommended for use during pregnancy.”
New prevention methods for GBS disease can have a major impact in low-income countries, where no current prevention strategy currently exists. They can also make a difference in high-income countries like the U.S., with fewer mothers and babies falling through the cracks. There is a 1 in 200 chance a baby will develop GBS disease if a mother carrying the bacteria does not get antibiotics during labor, according to the CDC.
Although a crucial safety measure, antibiotics are also not 100 percent effective at preventing GBS disease in newborns. According to the CDC, about 1 in 4,000 babies become infected even when a mother carrying GBS does receive antibiotics.
“Working on something that has the potential to improve babies and their families’ lives is really rewarding,” Natalie says. “And a GBS vaccine has such huge potential for public health impact, which is inspiring to me.”
Taking on GBS together
Natalie and Kelsey have different backgrounds but a common goal: Helping families avoid the devastation GBS can cause. The two women met at Pfizer’s Pearl River, NY office to discuss GBS and potential advances being made in the lab.
Together, they read a letter Kelsey had written detailing her experience with GBS. In it, Kelsey asks what scientists like Natalie and health care workers like herself can do to better protect newborn infants in similar situations.
Natalie explains the potential vaccine her team is working on and why it matters.
“GBS colonization can come and go,” Natalie says as Kelsey nods knowingly. A pregnant individual may test negative at 36 weeks, but, “by the time they give birth they could be positive.”
“It never crossed my mind until it happened to us,” Kelsey says. “It was shocking and devastating too, because I think I’m always going to feel like it’s my fault that it happened to him.”
“It’s not your fault if you’re colonized with Group B Strep,” Natalie assures her. “Many people can be colonized with Group B Strep and nothing happens. It’s a part of the normal microbiome. You can be healthy and your baby can be healthy, but it is definitely a risk factor for disease.”
Kelsey thanks Natalie for the work she’s doing and recalls discussing potential prevention options like this vaccine with her colleagues years earlier.
“Even if one person would benefit from it, it would definitely be worth it because I would never want what happened with our son to happen to anybody else’s child,” Kelsey says. “It’s comforting to know that there are people out there striving to make sure that it doesn’t.”
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