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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 .

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integrated perinatal infections surveillance the labor and delivery record to the rescue

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
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
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
slide5
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slide6
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perinatal infections surveillance current approaches
Perinatal infections surveillance: Current approaches

Provider surveys (eg,ACOG)

NCHS natality files

PRAMS

Active Bacterial Core surveillance

FoodNet

HIV strain surveillance

Disease-specific surveillance

(eg, rubella, syphilis, sepsis)

what is missing from these systems
What is missing from these systems?

Sustained tracking of prevention practices

(this becomes even more important as disease incidence declines)

the birth of birth net
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
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
slide12

GBS and Hepatitis B antenatal testing,

1998-9, ABCs

Schrag et al. 2003. Obstet Gynecol 102:753-60

slide13

The impact of state laws on HIV testing,

1998 and 1999, ABCs

Opt-out policy

Mandatory NB testing of HIV unknown mothers w/48h results, fall, 1999

Schrag et al. 2003. Obstet Gynecol 102:753-60

how birth net data have been used
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
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
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
Acknowledgments

Anne Schuchat

Elizabeth Zell

Aaron Roome

Katie Arnold

Janet Mohle-Boetani

Ruth Lynfield

Monica Farley

The Active Bacterial Core surveillance team