Group B Streptococcus (Newborn Babies)

Andrew Selous Excerpts

Thursday 7th November 2013 Commons Chamber

[Nadine Dorries]

Researchers stated:

“The most striking finding that has implications for clinical practice and policy is the low sensitivity of risk factor based screening, compared with PCR or culture tests in predicting maternal and neonatal GBS colonisation—”

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly commend my hon. Friend on bringing the issue before the House. I have a constituent who lost a child as a result of it, so it is something that I take seriously. Is my hon. Friend pleased, as I am, to see that Public Health England is now adopting gold standard enriched culture testing in its eight regional laboratories? Does she welcome that as a small advance in this important area?

[Nadine Dorries]

I welcome my hon. Friend’s intervention, and I will go on to talk about the gold standard culture medium.

The researchers continued that the sensitivity of such screening was

“below that which we considered to be a minimally acceptable sensitivity for our study—which calls into question the validity of the current UK policy. Moreover, consistent with previous evidence of practice variation, the risk factor-based screening policy was poorly adhered to, with one-third of women with indications for IAP not treated.”

Despite those authors and numerous others recommending routine screening as cost-effective in the UK, the UK national screening committee continues to recommend the risk-based approach.

Most countries that have national strategies against GBS infection offer routine antenatal testing for GBS. Those countries have seen the incidence of early onset disease fall dramatically, such as by more than 80% in the US and Spain. That compares favourably with the result of the risk-based approach in the UK under which, as I have said, the number of infections has increased. If we know that the risk-based strategy we are adopting is not working because infections are beginning to increase, yet countries such as Spain are seeing an 80% reduction, should we not consider the cost-effectiveness of moving to a system that we know will reduce the number of poorly babies in our intensive care units that have GBS-induced meningitis and other complications?

Studies show that testing for GBS in late pregnancy, as well as offering tests to women found to carry GBS or who have other recognised risk factors, is more cost-effective than the current risk-based strategy. A risk-based strategy is poor at predicting women who will be carrying GBS in labour, and therefore women for whom antibiotics in labour would potentially prevent devastating infections in their newborn babies.

Recently published research shows that although women want to be informed about GBS and offered testing for it during pregnancy, that is not happening. At less than £12, the tests are not that expensive, and the antibiotic recommended during labour if a woman is found to carry GBS in pregnancy is cheap and cost-effective. It is penicillin, which is shown to be exceptionally safe, as well as being a narrow-spectrum drug that is unlikely to cause greater resistance later.

Most NHS pathology services currently use culture media that are general purpose and identify GBS in only about 60% of carriers. At the request of the chief medical officer, Dame Sally Davies, the enriched culture medium test that my hon. Friend mentioned will be made available throughout England from 1 January 2014. That will identify about 90% of carriers, and it is the gold standard for that purpose, under Public Health England’s regional laboratory standard operating procedure. The results of the GBS test are about 85% predictive of carriage status for up to five weeks. It should be used to identify GBS carriage wherever there is an indication. These sensitive tests have not previously been widely available within the NHS when requested by the health professionals and pregnant women.

I have some key questions for the Minister. Will he use this debate as an opportunity to make a statement welcoming the gold standard enriched culture medium test for group B strep carriage, which is being made available from January 2014 and which can be used to assess carrier state if there is an indication? From this point on, how does the Minister plan to reduce the incidence of GBS infection in newborn babies when the current risk-based strategy, introduced in 2003, has been shown not to be effective? Is there a target rate for GBS infection in newborn babies? I have always derided targets, but in this case setting a target for the reduction of GBS infections may be a way to introduce routine testing.

Will the Minister confirm that the audit of practice suggested by the UK national screening committee to establish how well the new guidance is being implemented at a national level will study the actual practice taking place in maternity units, rather than simply being an audit of policies without any check on whether they are being applied in practice, because we know that these policies are not being put into practice in maternity units? What is the time scale for the feedback and advice to trusts about how they can further improve their adherence to the RCOG and National Institute for Health and Care Excellence guidelines on the prevention of neonatal GBS disease? What provision is being made for telling pregnant women about the risk of GBS infection in their babies? What provision is being made to educate relevant health professionals about the prevention of GBS in newborn babies and the forthcoming availability of the gold standard ECM test? Do midwives and practitioners in maternity units even know that this gold standard test is being introduced in 2014?

UK guidelines recommend that when GBS carriage is found by chance during a pregnancy, it should trigger the offer of antibiotic prophylaxis in labour. Why should a woman with unknown GBS carriage status be denied the opportunity to find out if her baby is at risk?

I would like to pay tribute to the tireless work of Group B Strep Support, the charity and campaign group that has been working to raise awareness of this issue and reduce the death toll. I also have a constituent who has sadly lost a baby to GBS. The group has been a great help to me in preparing for this debate following a meeting with my constituent. Ten years ago, my right hon. Friend the Prime Minister said in his Adjournment debate:

“Group B Strep Support’s aim, which I support, is for the routine test to be offered to all pregnant women, with those who are found to have GBS at the 35 to 37-week stage being automatically offered intravenous antibiotics.”

He said to the then Minister:

“I hope that the Minister will show great urgency over the issue”.—[Official Report, Date; Vol. 408, c. 267WH.]

My right hon. Friend supported the introduction of routine testing: I echo his sentiments exactly.

--- Later in debate ---

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

[Andrew Selous]

Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.