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Improving Haemophilus influenzae Serotype Reporting

Improving Haemophilus influenzae Serotype Reporting. Kristin Brown, MPH March 19, 2008. Haemophilus influenzae (Hi) Serotypes. Six capsular serotypes: a, b, c, d, e, & f H. influenzae type b (Hib) caused 95% of all invasive disease in the pre vaccine era

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Improving Haemophilus influenzae Serotype Reporting

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  1. Improving Haemophilus influenzae Serotype Reporting Kristin Brown, MPH March 19, 2008

  2. Haemophilus influenzae (Hi) Serotypes • Six capsular serotypes: a, b, c, d, e, & f • H. influenzae type b (Hib) caused 95% of all invasive disease in the pre vaccine era • Hib was leading cause of bacterial meningitis and other serious invasive diseases among children <5 years • Hib vaccine introduced for infants in 1988 and recommended in 1991

  3. National Hi Surveillance • Invasive Hib is a nationally notifiable disease • Invasive Hib in children < 5 years reportable in all states • Reporting for other ages vary from state to state • Reporting of invasive non-type B disease also varies • States report cases weekly to the National Notifiable Diseases Surveillance System (NNDSS) • All states report “core” demographic data • Most states report “extended” epidemiologic data

  4. Why do we care about the serotype? • Locally • Determine appropriate public health response • Detect clusters or changes in local epidemiology • Nationally • Detect changes in Hib incidence or epidemiology • Evaluate and inform Hib vaccine policy

  5. What was wrong with the national Hi serotype data? • There wasn’t very much of it • Serotype was reported for only 30% of cases in children < 5 years • 204 of 293 cases were reported as unknown or not tested or had no serotype data reported • Reporting of serotype declining over the past few years Serotype distribution in children < 5 years N = 293 *Includes cases with serotype unknown/not typed and cases with no data for serotype

  6. Hi Serotype Reporting: 2006 Provisional vs. Past Years Year Children < 5 years only 1994 – provisional 2006, NNDSS Past years include additional data collected through other mechanisms

  7. Project Goals • Improve national serotype data so national surveillance could be used to detect changes in Hib incidence in children < 5 years of age • Specific tasks were identified • Determine what additional serotype data was available to supplement NNDSS serotype data • Determine why the proportion of cases with reported serotype were decreasing in national surveillance systems

  8. Methods • Assessed data quality for each state • Abrupt changes • Patterns across states • Consist data quality • Prioritized states for follow-up • No serotype data • System-related data problems • States for which there was no other source of serotype data

  9. Methods • Contacted state health departments • Referred system problems to National Center for Public Health Informatics (NCPHI) • Collected information from additional sources • Active Bacterial Core Surveillance (ABCs) • Data sent from states who were not able to correct data in NNDSS prior to closing

  10. Most common problem with serotype data • Abrupt loss of data • Similar data changes across states Percent with Serotype reported Cases reported to NNDSS

  11. Hi Serotype Reporting Problems: • Incorrect mapping of data from NEDSS to NETSS • No extended Hi data • Serotypes other than B becoming ‘unknown’ • States began using new systems • Some were not set up to transmit extended Hi data to NETSS • Serotype more difficult to enter into newer systems and or could be entered into different fields

  12. Serotype reporting for case in children < 5 years, 2006 Cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and additional serotype data

  13. Serotype of Reported Hi in children < 5 years, 1994-2006 Number of cases Year Cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and additional serotype data

  14. Strategies to Improve Serotype Data • Increase communication between CDC and states • Direct access for the CDC program to NEDSS data • Efforts underway to get direct access to NEDSS data • HL7 messages for Hi planned for 2008 so states can begin sending data to NEDSS • Supplementing NNDSS surveillance data with data from other sources

  15. Serotype of Reported Hi in children < 5 years, 1994-2007 provisional Number of cases Year Cases reported to the National Notifiable Diseases Surveillance System (NNDSS) and additional serotype data

  16. Serotype Distribution, 2006 & 2007 Children < 5 years

  17. Acknowledgements • State Health Departments • Active Bacterial Core Surveillance sites • CDC Colleagues • Ben Silk • Kim Cushing • Pam Srivastava • Sandra Roush • Fatima Coronado

  18. If you would like to discuss your state’s data contact Kristin Brown by phone (404) 639-6247 or by email khbrown@cdc.gov

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