---
title: "Group B Streptococcus Rectovaginal Colonization and Serotypes in Pregnant Women, Asia-Pacific (201"
id: "cdc-emerging-infectious-diseases-journal-0-systematic-review-and-meta-analysis-of-group-b-streptococcus-rectovaginal"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-0-systematic-review-and-meta-analysis-of-group-b-streptococcus-rectovaginal"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article"
published_at: "2026-09-17T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Group B Streptococcus Rectovaginal Colonization and Serotypes in Pregnant Women, Asia-Pacific (201
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-0-systematic-review-and-meta-analysis-of-group-b-streptococcus-rectovaginal
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article)
- **Published At:** 2026-09-17T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- Systematic review and meta-analysis assessed maternal rectovaginal **Group B Streptococcus (GBS)** colonization, serotype distribution, and antimicrobial resistance (AMR) in the Asia-Pacific region using studies published January 2014–October 2025. - Searches covered MEDLINE, Embase (OVID), and PubMed; the protocol was registered in PROSPERO (CRD42024535368) and reporting followed PRISMA 2020. - From 1,623 identified records, 98 studies met inclusion criteria and were included in meta-analysis after excluding high risk-of-bias studies. - Across included studies, 978,150 pregnant women were tested and 172,973 were colonized; pooled prevalence was **18.0%** (95% CI 12%–23%). - Serotype data were reported in 24 studies; **serotype III** was the most frequently identified serotype, with study-level proportions ranging from 5.0% to 100.0%. - Thirty studies reported AMR data; very low resistance (0%–2.0%) was observed to **β-lactams** (first-line agents such as penicillin/ampicillin) in the sampled studies. - Study selection and data extraction used Covidence; quality appraisal used the Joanna Briggs Institute tool for cross-sectional studies; analyses used a random-effects inverse variance model in Stata 19.0. - Noted geographic gaps: limited data from Southeast Asia and the Pacific/Oceania subregions; authors recommend continued surveillance to guide prevention and treatment programs, particularly in underrepresented areas. - Limitations reported include restriction to English-language publications and exclusion of studies with <50 pregnant women or insufficient laboratory-derived prevalence data.
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1346) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F10%2F26-0687_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F10%2F26-0687_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F10%2F26-0687_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/10/26-0687_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 10—October 2026 ##### _Synopsis_ ### Systematic Review and Meta-analysis of Group B _Streptococcus_ Rectovaginal Colonization Rates and Serotype Distribution among Pregnant Women, Asia-Pacific Region, 2014–2025 On This Page [Methods](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) * * * [Results](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) * * * [Discussion](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) Figures [Figure 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-f1) * * * [Figure 2](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-f2) Tables [Table 1](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-t1) * * * [Table 2](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-t2) Downloads [Appendix ](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-app1.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/10/26-0687.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article) Related Articles [Macrolide-Resistant _Bordetella pertussis_ , Peru](https://wwwnc.cdc.gov/eid/article/32/10/25-1477_article) * * * [_Salmonella_ Infantis Carrying _bla_ CTX-M-65 Gene](https://wwwnc.cdc.gov/eid/article/32/10/25-1758_article) * * * [Global Spread of _Trichophyton indotineae_](https://wwwnc.cdc.gov/eid/article/32/9/26-0463_article) * * * [More articles on Antimicrobial Resistance](https://wwwnc.cdc.gov/eid/spotlight/antimicrobial-resistance) Zheng Quan Toh[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#comment) , Lien Anh Ha Do, Darren Suryawijaya Ong, Claire von Mollendorf[1](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#fn1), and Fiona M. Russell[1](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#fn1) Author affiliation: Murdoch Children’s Research Institute and University of Melbourne, Parkville, Victoria, Australia [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#suggestedcitation) ### Abstract We conducted a systematic review and meta-analysis of group B _Streptococcus_ (GBS) rectovaginal colonization prevalence, serotype distribution, and antimicrobial drug resistance (AMR) rates among pregnant women in the Asia-Pacific region. We included articles published in the MEDLINE, Embase, and PubMed databases during January 2014–October 2025. Overall, 1,623 studies were identified; 98 of those were included in the meta-analysis. Of 978,150 pregnant women, 172,973 were colonized with GBS; pooled estimated prevalence was 18.0% (95% CI 12%–23%). Studies from Southeast Asia were limited. GBS serotype distributions were reported in 24 studies; serotype III was the most common (range 5.0%–100.0%). Thirty studies included AMR rates; low (0%–2.0%) AMR rates were found for β-lactams. GBS colonization is common among pregnant women in the Asia-Pacific region. Continued surveillance of GBS prevalence will be needed, particularly in Pacific and Southeast Asian countries, to guide effective GBS prevention and treatment programs. Group B _Streptococcus_ (GBS), also known as _Streptococcus agalactiae_ , is a gram-positive bacterium that causes substantial infant illness and death worldwide ([_1_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r1 "1")). Approximately 400,000 cases of neonatal invasive GBS disease and >90,000 deaths associated with GBS infections occur globally each year ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r2 "2")–[ _4_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r4 "4")). Most GBS cases and associated deaths occur in low- and middle-income countries, where access to antenatal screening and treatment is limited ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r2 "2")–[ _4_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r4 "4")). Maternal rectovaginal GBS colonization is a major risk factor for invasive GBS disease in pregnant women and neonates ([_5_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r5 "5")). Pregnant women who have rectovaginal GBS colonization can transfer bacteria to their fetuses or newborn infants during delivery, causing early onset of neonatal invasive GBS disease. To reduce GBS transmission, most high-income countries offer intrapartum antibiotic prophylaxis (IAP) to GBS-positive pregnant women, screened at 35–37 weeks’ gestation, or to women who have established risk factors for GBS colonization. Risk factors include prolonged rupture of amniotic membranes, GBS bacteriuria during pregnancy, intrapartum maternal fever, and having previously delivered an infant who had early-onset GBS disease ([_6_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r6 "6")). Penicillin or ampicillin is the first-line antimicrobial treatment for GBS infection; clindamycin or vancomycin is used for persons who are allergic to penicillin ([_7_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r7 "7")). However, low-income countries face major challenges in implementing GBS screening and IAP, including lack of national GBS screening guidelines and programs, limited access to prenatal care, lack of laboratory resources for testing, and high prevalences of home births ([_8_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r8 "8"),[_9_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r9 "9")). Furthermore, frequent use of antimicrobial drugs has raised concerns regarding the emergence of antimicrobial drug resistance (AMR) ([_10_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r10 "10")). Systematic reviews of global maternal rectovaginal GBS colonization up to January 2020 reported the average colonization rate to be 14%–18%; the highest prevalences occurred in Africa and central and South Asia ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r2 "2"),[_11_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r11 "11"),[_12_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r12 "12")). Those reviews contained limited data from the Asia-Pacific region, particularly the Oceania subregion ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r2 "2"),[_11_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r11 "11"),[_12_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r12 "12")). Maternal GBS colonization rates were used to estimate global and regional prevalence of invasive GBS in infants; estimates for the Oceania subregion were extrapolated from other regional data ([_2_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r2 "2")). Among the 10 GBS serotypes, Ia, III, and V were the most common serotypes found in maternal colonization and accounted for >60% of invasive GBS disease in infants ([_13_](https://wwwnc.cdc.gov/eid/article/32/10/26-0687_article#r13 "13")), although serotype distribution varied by region. Serotypes VI–IX were more common in Asia (6%–16%) and West Africa (15%) than in Europe ( [External Link](https://www.crd.york.ac.uk); registration no. CRD42024535368). We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines ( [External Link](https://www.prisma-statement.org)) for reporting systematic review data. ##### Search Strategy and Selection Criteria We included articles published during January 1, 2014, to October 31, 2025, in MEDLINE ( [External Link](https://www.nlm.nih.gov/medline)) and Embase ( [External Link](https://www.embase.com)) using the OVID platform ( [External Link](https://www.ovid.com)). We used Medical Subject Headings and thesaurus terms and keywords. We searched PubMed ( [External Link](https://pubmed.ncbi.nlm.nih.gov)) for articles not yet indexed. We used search terms related to _Streptococcus agalactiae_ , carriage, mothers, pregnancy, and Asia-Pacific. We limited our search to studies published in English ([Appendix](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-app1.pdf)). We included studies reporting GBS colonization rates in pregnant and postpartum women and those reporting samples obtained from vaginal, rectal, or perianal regions. We included all observational and case studies reporting GBS prevalence in pregnant women from East Asia, South Asia, Southeast Asia, and Oceania. We excluded studies of pregnant women when GBS prevalence estimates were derived from [External Link](https://www.covidence.org)) for screening. Two authors independently screened the titles and abstracts of the studies; Z.Q.T. screened 100%, and L.A.H.D. screened 10% of randomly selected papers. We excluded duplicate articles during the Covidence uploading and screening stages. Z.Q.T. and L.A.H.D. each independently performed 100% of full-text study screening. The 2 reviewers resolved any disagreements at the screening or full-text stages through mutual consensus. ##### Data Extraction and Quality Assessment One reviewer (Z.Q.T.) extracted data by using Covidence and Microsoft Excel ( [External Link](https://www.microsoft.com)) tables. Extracted data included country, study period, study design, study population, gestational age at time of sampling, number of pregnant women tested, number of women with detected GBS, method of detection (culture or molecular, with or without enrichment), sampling site (vagina, rectum, or perianal region at any time during pregnancy), serotype distribution, serotyping methods, AMR rates, and AMR testing method. We used the Joanna Briggs Institute Critical Appraisal Tool (https://jbi.global/critical-appraisal-tools) for analytical cross-sectional studies to assess the risk of bias scores in the studies; Z.Q.T. performed the assessment. We selected that risk of bias tool because our review focused on the prevalence of GBS colonization, and most studies were observational. We addressed 8 criteria ([Appendix](https://wwwnc.cdc.gov/eid/article/32/10/26-0687-app1.pdf) Table 1). A yes response received a score of 1, whereas a no or unclear response received a score of 0. We considered a total score of 6–8 as low risk, 3–5 as moderate risk, and 0–2 as high risk for bias. ##### Data Analysis We generated data by using Microsoft Excel and analyzed those data by using Stata version 19.0 (StataCorp LLC, [External Link](https://www.stata.com)). We excluded studies from the meta-analysis that had a high risk for bias (score <3). We pooled GBS prevalences by using a random-effects inverse variance model, weighted by sample size. This model assumed that studies included in the meta-analysis were a random sample from a larger population of studies and that prevalences
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