births that occur up to a gestational age of at least 41 weeks. in 2019, american academy of pediatrics (aap) published a new clinical report—management of infants at risk for gbs neonatal disease. this aap's clinical report replaces the 2010 guidelines published by cdc. asm states that it is acceptable to use naat-based identification of gbs from enrichment broth (after 18-24-hour incubation) with high sensitivity, and that fda-cleared commercial assays are available to perform the test. however, direct-from-specimen naats is not recommended due to low sensitivity with high rates of false negative results. moreover, acog has a favorable view of the use of naats and states that naats from enrichment broth testing is reasonable, has higher sensitivity for detecting gbs than culture, and, therefore, a possibly better test. this recommendation is based on data proving the valuable utility of the test. unlike asm, acog also allows for the use of naats without the enrichment broth, despite the high false negative rate, as a rapid (point-of-care) test for women who present in labor with unknown gbs status. however, both asm and acog acknowledge that naat-based testing does not have the capability to provide the antibiotic susceptibility needed to identify the iap regimen needed for women with a penicillin allergy. other guidelines national guidelines in most developed countries advocate the use of universal screening of pregnant women late in pregnancy to detect gbs carriage and use of iap in all colonized mothers. e.g. canada, spain, switzerland, germany, poland, czech republic, france, and belgium. in contrast, risk factor-based guidelines were issued (in addition to the uk) in the netherlands, the royal australian and new zealand college of obstetricians and gynaecologists does not recommend clearly one of both prevention strategies -either the risk-based or the culture-based approach to identify pregnant women for iap, and allow practitioners to choose according jurisdictional guidelines. adults gbs is also an important infectious agent able to cause invasive infections in adults. serious life-threatening invasive gbs infections are increasingly recognized in the elderly and in individuals compromised by underlying diseases such as diabetes, cirrhosis and cancer. gbs infections in adults include urinary tract infection, skin and soft-tissue infection (skin and skin structure infection) bacteremia without focus, osteomyelitis, meningitis and endocarditis. gbs infection in adults can be serious, and mortality is higher among adults than among neonates. in general, penicillin is the antibiotic of choice for treatment of gbs infections. erythromycin or clindamycin should not be used for treatment in penicillin-allergic patients unless susceptibility of the infecting gbs isolate to these agents is documented. gentamicin plus penicillin (for antibiotic synergy) in patients with life-threatening gbs infections may be used. invasive gbs infections in non-pregnant adults convey a rising hardship in most developed countries. vaccination to prevent gbs infection could be a crucial approach to prevent gbs disease in adults. toxic shock syndrome (tss) is an acute multisystem life-threatening disease resulting in multiple organ failure. the severity of this disease frequently warrants immediate medical treatment. tss is caused primarily by some strains of staphylococcus aureus and streptococcus pyogenes that produce exotoxins. nevertheless, invasive gbs infection can be complicated, though quite infrequently, by streptococcal toxic shock-like syndrome (stls) society and culture july has been recognised as group b strep awareness month, a time when information about group b strep aimed at families and health professionals is shared, predominantly in the uk and the us. in the uk, this is led by group b strep support. vaccine though the introduction of national guidelines to screen pregnant women for gbs carriage and the use of iap has significantly reduced the burden of gbs-eod disease, it has had no effect on preventing either gbs-lod in infants or gbs infections in adults. because of this, if an effective vaccine against gbs were available, it would be an effective means of controlling not only gbs disease in infants, but also infections in adults. there are a number of problems with giving antibiotics to women in labor. such antibiotic exposure risks included severe allergic reactions and difficulties screening pregnant women for gbs. if pregnant women could be given a vaccine against gbs, this could potentially prevent most cases of gbs without the need for antibiotics or screening. vaccination is considered an ideal solution to prevent not only early- and late-onset disease but also gbs infections in adults at risk. development of gbs vaccines for maternal immunization has been identified as a priority by the world health organization on the basis of high unmet need. it has been estimated that such a vaccine could potentially prevent 231,000 infant and maternal gbs cases. as early as 1976, low levels of maternal antibodies against the gbs capsular polysaccharide were shown to be correlated with susceptibility to gbs-eod and gbs-lod. maternal-specific antibodies, transferred from the mother to the newborn, were able to confer protection to babies against gbs infection. the capsular polysaccharide of gbs, which is an important virulence factor, is also an excellent candidate for the development of an effective vaccine. gbs protein-based vaccines are also in development and are greatly promising as they will be able to protect against gbs infection of any serotype. at present, the licensing of gbs vaccines is difficult because of the challenge in conducting clinical trials in humans due to the low incidence of gbs neonatal diseases. nevertheless, though research and clinical trials for the development of an effective vaccine to prevent gbs infections are underway, no vaccine is available as of 2021. nonhuman infections gbs has been found in many mammals and other animals such as camels, dogs, cats, seals, dolphins, and crocodiles. cattle in cattle, gbs causes mastitis, an infection of the udder. it can produce an acute febrile disease or a subacute, more chronic disease. both lead to diminishing milk production (hence its name: agalactiae meaning "no milk"). mastitis associated with gbs can have an important effect on the quantity and quality of milk produced, and is also associated with elevated somatic cell count and total bacteria count in the milk. outbreaks in herds are common, and as this is of major significance for the dairy industry, programs to reduce the impact of gbs have been enforced in many countries fish gbs it is also an important pathogen in a diversity of fish species, leading to serious economic losses in many species of fish worldwide. gbs causes severe epidemics in farmed fish, causing sepsis and external and internal hemorrhages. gbs infection has been reported from wild and captive fish and has been involved in epizootics in many countries. vaccines to protect fish against gbs infections are under development.