integrated perinatal infections surveillance: the labor and delivery record to the rescue
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Integrated perinatal infections surveillance: the labor and delivery record to the rescue. MCH EPI Conference, 2004 Atlanta, GA Stephanie Schrag, D Phil Division of Bacterial and Mycotic Diseases Centers for Disease Control and Prevention. Perinatal infections burden. - PowerPoint PPT PresentationTRANSCRIPT
Integrated perinatal infections surveillance: the labor and
delivery record to the rescueMCH EPI Conference, 2004
Atlanta, GA
Stephanie Schrag, D PhilDivision of Bacterial and Mycotic Diseases
Centers for Disease Control and Prevention
Perinatal infections burden
• Pregnant and post-partum women– Pregnant women at increased risk for infections
or infectious complications (eg, influenza)– 78% of childbirth-related prolonged
hospitalizations are due to infection*
• Neonates– Perinatal sepsis among top 10 causes of death– Infection contributes to preterm delivery– Early infections contribute to severe lifelong
morbidity*Hebert et al., Obstet Gynecol. 1999. 94:942-7
Unique opportunities for prevention of perinatal infections
• Limited time frame for disease transmission• Eradication of pathogen in mother not always
required to prevent transmission• Health care provider plays key role in prevention
implementation– Pre-conception, prenatal and intrapartum interventions
• Interventions can greatly reduce disease– Perinatal GBS disease: 39,000 prevented since 1993– Congenital rubella syndrome: 1 US case last year
Surveillance integration challenges
1.
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+ …..
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NCHS natality filesPRAMS
Active Bacterial Core surveillance FoodNet HIV strain surveillance
Disease-specific surveillance (eg, rubella, syphilis, sepsis)
Provider surveys (eg,ACOG)
Perinatal infections surveillance: Current approaches
What is missing from these systems?
Sustained tracking of prevention practices
(this becomes even more important as disease incidence declines)
The labor and delivery (L&D) record
The birth of Birth-Net
• Periodic, population-based review of L&D records in Emerging Infections Program (EIP) areas (selected counties in 11 states)
• Idea grew out of state hepatitis B prevention programs
• The EIPs have conducted two L&D reviews and are planning a review of 2003/2004 births
Birth-Net design and methods• Weighted sample survey using state birth
certificate file as sampling frame for random selection of births (app. 400-600) from each state
• Abstraction of L&D records using a standard form that includes:– maternal demographics and prenatal visits– perinatal infections screening counseling, tests
and results (syphilis, rubella, HIV, hepatitis B, GBS, toxoplasma)
– brief L&D history– prevention interventions administered
GBS and Hepatitis B antenatal testing, 1998-9, ABCs
0102030405060708090
100
MD NY CT GA TN CA MN OR
% t
este
d
GBSHbSAg
Schrag et al. 2003. Obstet Gynecol 102:753-60
The impact of state laws on HIV testing,1998 and 1999, ABCs
0102030405060708090
100
TN MD GA MN NY CA CT OR
% t
este
d
Schrag et al. 2003. Obstet Gynecol 102:753-60
Mandatory NB testing of HIV unknown mothers w/48h results, fall, 1999
Opt-out policy
How Birth-Net data have been used• Revise perinatal group B streptococcal
disease guidelines to recommend universal prenatal screening
• Guide rubella post-partum vaccination policies
• Provide local feedback to promote prevention efforts
• Evaluate impact of prenatal testing laws• Evaluate accuracy of birth certificate data
Challenges / Limitations
• Timeliness: birth certificate files are available 3-9 months after close of calendar year
• Survey design and analysis: requires calculation of sample weights and familiarity with sample survey analysis
• Labor: Person time for chart review; resolving HIPAA issues etc.
• Limitations of L&D record: limited prenatal care information; limited baby information; limited maternal demographics; not everything that happens is documented
Vision for the future• Expansion of Birth-Net to non-EIP states
– A CDC HIV-led project has the objective of developing a “how to” manual for states
• Improved integration of infectious issues into Birth-Net– Improved collaboration within CDC (eg,
Perinatal Infections Working Group)– Improved integration in state health depts
(eg, CT)
• Improved integration of non-infectious MCH issues into Birth-Net
Acknowledgments
Anne SchuchatElizabeth ZellAaron RoomeKatie ArnoldJanet Mohle-BoetaniRuth LynfieldMonica FarleyThe Active Bacterial Core surveillance team