Increased use of intrapartum antibiotics to prevent perinatal group B streptococcal (GBS) disease during the 1990s led to substantial declines in the incidence of GBS disease in newborns. Despite this success, at the end of the 1990s, early-onset GBS disease (in infants aged <7 days) continued to be a leading infectious cause of neonatal mortality in the United States, and black infants remained at higher risk than white infants. In 2002, CDC and the American College of Obstetricians and Gynecologists (ACOG) revised guidelines for prevention of early-onset GBS disease to recommend late prenatal screening of all pregnant women and intrapartum antibiotic prophylaxis (IAP) for GBS carriers. These guidelines were expected to result in further declines in early-onset disease. This report updates early-onset incidence trends since 1999 analyzed by using population-based, multistate data from the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network. The results of the analysis indicated that 1) after a plateau in early-onset disease incidence during 1999-2002, rates declined 34% in 2003 and 2) although racial disparities in incidence persist, rates for blacks now approach the 2010 national health objective of 0.5 cases per 1,000 live births. Continued implementation of screening and prophylaxis guidelines by clinicians and public health practitioners should lead to further declines in racial disparities.