Description
Reductions in infant mortality (IM) and of the years of potential life lost (YPLL) are major targets of National Health Plans and Programs. Here we propose to survey the characteristics of Streptococcus agalactiae (Lancefield group B streptococci – GBS) causing human infections in Portugal and Iceland, focusing on two major risk groups: young infants and adults suffering from diabetes. This will raise the awareness of GBS infection, contributing to a stronger adherence to antibiotic prevention policies for neonatal infections and to a better management of adult infections, leading to reductions in IM and YPLL. A greater understanding of the disease in these two at risk populations will clarify if the same GBS genetic lineages are present in both populations. This can be critical to identify particularly pathogenic lineages for certain hosts or to cause certain disease presentations, identifying them as targets for specific prevention or treatment strategies.
Summary of project results
Reductions in infant mortality and of the years of potential life lost are major targets of National Health Plans. Streptococcus agalactiae (Lancefield group B streptococci – GBS) is responsible for invasive disease in neonates and is also recognized as an important pathogen in adults, responsible for significant morbidity and mortality. GBS incidence is seemingly increasing with age, perhaps due to the higher prevalence of risk factors like cancer and diabetes. The promoter proposed to survey the characteristics of GBS in Portugal and Iceland, focusing on two major risk groups: young infants and adults with diabetes. The main goals were to raise the awareness of GBS infection, contributing to a stronger adherence to antibiotic prevention policies for neonatal infections and to a better management of adult infections. This will be critical to identify particularly pathogenic lineages for certain hosts or to cause certain disease presentations, identifying them as targets for specific prevention or treatment strategies. Firstly, by producing information on GBS infection and by enlisting a large number of Clinical Microbiology laboratories in both countries in the surveillance activities the project raised awareness on GBS infections. Secondly, the information obtained by identifying circulating clones and their characteristics, including susceptibility to a panel of antimicrobials, among which are those most frequently used in therapy and prophylaxis, contributed for the stated aim for “Improving the prevention and treatment of communicable disease in Portugal" and also provided important surveillance information on the emergence of antibiotic resistance in GBS. The project has enabled improvements in capacity building using high-throughput screening (HTS) methodology for bacterial molecular epidemiology and offered improvements for the information system not only by improving information quality, but also through development of software tools, already shared freely with the scientific community. Also, the fact that information made available through the project activities on capsular serotype distribution will help guide the development of a capsular polysaccharide conjugate vaccine formulation and will contribute for the evaluation of cost-effectiveness of current vaccination practices supporting improvements in Portuguese vaccination guidelines.
Summary of bilateral results
The Icelandic partner was crucial to obtain retrospective information on cases of GBS infection in Iceland as well as for the prospective identification of cases occurring in Iceland during the project. The partner also provided collections of GBS isolates causing infections for further characterization. These were obtained from nationwide surveillance networks coordinated by the partner. A member of the Icelandic team travelled to Portugal for a time to work with Portuguese team members in the characterization of isolates recovered in Iceland. This visit served not only the purpose of advancing the characterization of the isolates, but also to train the Icelandic team member in techniques that were used in the Portuguese partner laboratory but that were not in common use in the Icelandic partner laboratory. The Icelandic team members have been involved in the analysis of the data produced and in the preparation of the communications and papers related to the project. Apart from their scientific and intellectual contributions, their knowledge and insight of Iceland and its specificities have been essential to properly contextualize the information obtained. The Icelandic partner received no funding under this grant proposal. The Portuguese partner provided retrospective information on cases of GBS infection in Portugal as well as prospective identification of cases occurring in Portugal during the project. The partner provided collections of GBS isolates causing infections for further characterization. These were obtained from nationwide surveillance networks coordinated by the partner. The characterization of all isolates collected in both Iceland and Portugal was accomplished in the Portuguese partner laboratories. The Portuguese team provided the technical expertise as well as the facilities necessary to perform the phenotypic and genotypic characterization of the isolates as proposed in the project. The Portuguese team developed the necessary software to analyze the genomic data generated within the project. The team also led the communication efforts.