Abstract
BACKGROUND: Streptococcus agalactiae (Group B Streptococcus, GBS) is a leading cause of invasive neonatal and infant infections, including sepsis and meningitis. This study aimed to estimate the vaccine coverage and characterize the genomic features of pediatric invasive GBS in Japan. METHODS: We conducted a nationwide, multicenter, retrospective genomic surveillance study involving 237 GBS isolates from sterile specimens of children aged ≤15 years across 35 hospitals in Japan between 2004 and 2023. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS: The estimated vaccine coverage was 98.3% for the hexavalent polysaccharide vaccine and 94.9% for the GBS-NN/NN2 protein vaccine. Erythromycin and clindamycin resistance were observed in 61.2% and 43.5%, respectively. Among the 75 CC17 isolates, 59 (78.7%) contained only PI-2B and harbored both ermB and tetO, indicating the predominance of a multidrug-resistant clone. Single nucleotide polymorphism-based analysis revealed evidence of nosocomial transmission and persistent regional circulation, particularly within the ST17 and ST23 lineages. CONCLUSIONS: This study suggests that current maternal GBS vaccine candidates would provide broad coverage for pediatric invasive infections in Japan. The identification of persistent and regionally disseminated lineages highlights the importance of investigating potential, yet, poorly understood, transmission routes, including environmental reservoirs, to inform future prevention strategies.