{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:18:37Z","timestamp":1789654717882,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,9]],"date-time":"2018-09-09T00:00:00Z","timestamp":1536451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>We describe cases of invasive group A <jats:italic>Streptococcus<\/jats:italic> (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28\u00a0days of birth and investigation of clusters in maternity units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional retrospective study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and population<\/jats:title><jats:p>Notified confirmed iGAS cases in either mothers or neonates with onset within 28\u00a0days of birth in London and the South East of England between 2010 and 2016<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Review of public health records of notified cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28\u00a0days postpartum was 109 (95% CI 90\u2013127) compared with 1.3 in other females aged 15\u201344. For neonates the incidence was 1.5 (95% CI 9\u201323). The median onset time was 2\u00a0days postpartum [interquartile range (IQR) 0\u20135\u00a0days] for mothers and 12\u00a0days (IQR 7\u201315\u00a0days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Are public health guidelines being followed in the management of mothers and their newborns to reduce the risk of iGAS infection?<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15415","type":"journal-article","created":{"date-parts":[[2018,8,3]],"date-time":"2018-08-03T13:21:10Z","timestamp":1533302470000},"page":"44-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010\u20132016: assessment of risk and audit of public health management"],"prefix":"10.1111","volume":"126","author":[{"given":"A","family":"Leonard","sequence":"first","affiliation":[{"name":"Field Epidemiology Service South East and London Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Wright","sequence":"additional","affiliation":[{"name":"Field Epidemiology Service South East and London Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Saavedra\u2010Campos","sequence":"additional","affiliation":[{"name":"Field Epidemiology Service South East and London Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Lamagni","sequence":"additional","affiliation":[{"name":"Healthcare\u2010Associated Infection and Antimicrobial Resistance Department National Infection Service Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Cordery","sequence":"additional","affiliation":[{"name":"South London Health Protection Team Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Nicholls","sequence":"additional","affiliation":[{"name":"South East PHE Centre Public Health England UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Domoney","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Sriskandan","sequence":"additional","affiliation":[{"name":"NIHR Health Protection Research Unit in HCAI and AMR Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Balasegaram","sequence":"additional","affiliation":[{"name":"Field Epidemiology Service South East and London Public Health England London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,9]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12892"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2011.411"},{"key":"e_1_2_8_4_1","volume-title":"Saving Lives, Improving Mothers\u2019 Care \u2013 Surveillance of Maternal Deaths in the UK 2012\u201014 and Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009\u201014","author":"Knight M","year":"2016"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001672"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.19.30532"},{"key":"e_1_2_8_7_1","first-page":"354","article-title":"Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease","volume":"7","author":"Health Protection Agency, Group A Streptococcus Working Group","year":"2004","journal-title":"Commun Dis Public Health"},{"key":"e_1_2_8_8_1","unstructured":"legislation.gov.uk [Internet].The Stationery Office; 2010. 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