Perinatal group B streptococcal disease prevention, Minnesota

In 2002, revised guidelines for preventing perinatal group B streptococcal disease were published. In 2002, all Minnesota providers surveyed reported using a prevention policy. Most screen vaginal and rectal specimens at 34-37 weeks of gestation. The use of screening-based methods has increased dramatically since 1998.     

Disparities in universal prenatal screening for group B streptococcus--North Carolina, 2002-2003

Group B streptococcus (GBS) is a leading cause of neonatal morbidity and mortality in the United States. Intrapartum antibiotics administered to women at risk for transmitting GBS to their newborns are effective in preventing perinatal GBS infection. In 2002, CDC, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists recommended universal prenatal screening for vaginal and rectal GBS colonization at 35-37 weeks' gestation. To examine prenatal GBS screening among pregnant women in North Carolina, CDC analyzed 2002 and 2003 data from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The proportions of women reporting prenatal screening for GBS were similar in 2002 and 2003 (70% and 74%, respectively); however, for both years, women of Hispanic ethnicity and women who received prenatal care at a hospital or health department clinic were less likely to report prenatal screening for GBS. These findings underscore the need to increase GBS-related education and prevention activities targeted to these populations.     

Diminishing racial disparities in early-onset neonatal group B streptococcal disease--United States, 2000-2003

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.     

孕妇孕晚期 GBS定植及新生儿早发型 GBS感染趋势

目的：观察孕晚期B族链球菌（ GBS）的定植情况以及母婴垂直传播率,评估新生儿早发型GBS疾病（ EOD）的发病趋势。方法选择2014年1月至2015年3月在南京医学院附属苏州母子医疗保健中心住院分娩的3487例孕妇进行阴道GBS筛查,根据美国疾病控制中心（ CDC）推荐的培养筛查策略评估孕妇孕晚期GBS的定植率;对1018对孕妇－新生儿配对病例进行垂直传播筛查,追踪新生儿结局,统计母婴垂直传播率及新生儿EOD的发病率。结果在培养筛查组,3487例孕妇标本中有142例GBS培养阳性,孕妇阴道GBS定植率为4．07％;在母婴垂直传播筛查组,1018对配对标本中,有52例孕妇GBS培养阳性,其分娩新生儿有4例阳性,垂直传播率为7．69％。在1062例纳入研究的新生儿中有1例发生EOD,其发病率为0．94‰（1／1062）。结论虽然孕妇孕晚期GBS定植率低,但其垂直传播率及新生儿EOD发病率均较高。有必要于有条件的地区进一步推行GBS产前筛查和相关治疗。     

Lyme disease--United States, 2003-2005

Lyme disease is caused by the spirochete Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks (Ixodes spp.). Early manifestations of infection include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. Left untreated, late manifestations involving the joints, heart, and nervous system can occur. A Healthy People 2010 objective (14-8) is to reduce the annual incidence of Lyme disease to 9.7 new cases per 100,000 population in 10 reference states where the disease is endemic (Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). This report summarizes surveillance data for 64,382 Lyme disease cases reported to CDC during 2003-2005, of which 59,770 cases (93%) were reported from the 10 reference states. The average annual rate in these 10 reference states for the 3-year period (29.2 cases per 100,000 population) was approximately three times the Healthy People 2010 target. Persons living in Lyme disease--endemic areas can take steps to reduce their risk for infection, including daily self-examination for ticks, selective use of acaricides and tick repellents, use of landscaping practices that reduce tick populations in yards and play areas, and avoidance of tick-infested areas.     

Early-onset and late-onset neonatal group B streptococcal disease--United States, 1996-2004

In 2002, CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) issued revised guidelines for prevention of perinatal invasive group B streptococcal (GBS) disease. These guidelines recommend universal screening of pregnant women for rectovaginal GBS colonization at 35-37 weeks' gestation and administering intrapartum antimicrobial prophylaxis to carriers. To assess the impact of the guidelines on multistate trends in neonatal GBS disease incidence, CDC analyzed data from the Active Bacterial Core surveillance (ABCs) system from 1996-2004. This report summarizes the results of that analysis, which determined that incidence of GBS disease in infants aged 0-6 days (i.e., early-onset disease) in 2004 had decreased by 31% from 2000-2001, the period immediately before universal screening was implemented. Incidence of GBS disease in infants aged 7-89 days (i.e., late-onset disease) remained unchanged during the 9-year period reviewed. Continued monitoring is needed to assess the impact of the 2002 guidelines on early-onset disease and the long-term effect of widespread intrapartum use of antimicrobial agents on neonatal GBS disease.     

Laboratory practices for prenatal group B streptococcal screening--seven states, 2003

In the United States, group B streptococcus (GBS) is the leading cause of serious bacterial infections in newborns. In 1996, consensus guidelines for use of intrapartum antibiotic prophylaxis (IAP) to prevent perinatal GBS disease recommended either of two methods for identifying candidates for chemoprophylaxis: 1) late prenatal culture-based screening for GBS colonization or 2) monitoring of women intrapartum for particular risk factors associated with early-onset GBS disease. Evidence that culture-based screening was substantially more effective than the risk-based approach led to revised guidelines in 2002 recommending late prenatal GBS screening for all pregnant women. Although methods for isolation and identification of GBS from prenatal specimens remained the same as those recommended in 1996, the 2002 guidelines recommended that laboratories perform antimicrobial susceptibility testing on prenatal GBS isolates from women at high risk for penicillin anaphylaxis and clarified that laboratories should report the presence of any GBS in urine specimens from pregnant women. To assess laboratory adherence to recommendations in the 2002 guidelines, CDC's Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network surveyed clinical laboratories about prenatal culture-processing practices in 2003. This report summarizes the results of that survey, which indicated that, although adherence to GBS isolation procedures was high, opportunities exist to improve implementation of recommendations related to antimicrobial susceptibility testing and GBS bacteriuria.     

Rapid HIV test distribution--United States, 2003-2005

At the end of 2003, an estimated 1 million persons in the United States were living with human immunodeficiency virus (HIV) infection, including those with acquired immunodeficiency syndrome (AIDS); approximately one fourth of these persons had not had their infections diagnosed. In 2003, CDC implemented a new initiative, Advancing HIV Prevention (AHP), focused, in part, on reducing the prevalence of undiagnosed HIV infection by expanding HIV testing and taking advantage of rapid HIV tests that enable persons to receive results within 30 minutes, instead of the 2 weeks typically associated with conventional tests. In support of AHP strategies, during September 2003-December 2005, CDC purchased and distributed rapid HIV tests to expand testing and assess the feasibility of using rapid tests in new environments (e.g., outreach settings or emergency departments). This report summarizes the results of this rapid HIV-test distribution program (RTDP), in which CDC distributed tests to 230 organizations in the United States and identified 4,650 (1.2%) HIV infections among 372,960 rapid tests administered. The results suggest that RTDP helped scale up rapid HIV-testing programs in the United States and enabled diagnosis of HIV in persons who might not have had their infections diagnosed otherwise.     

Public health surveillance for smallpox - United States, 2003-2005

In June 1987, nearly 10 years after the World Health Organization (WHO) declared smallpox eradicated, the Council of State and Territorial Epidemiologists (CSTE) recommended removal of smallpox, a highly contagious viral disease, from the National Notifiable Diseases Surveillance System (NNDSS). However, the attacks of September 11, 2001, raised concern that smallpox (variola) virus, might exist in laboratories other than two WHO-designated repositories and could be used as an agent of biologic terrorism. In response to this concern, CSTE and CDC recommended in June 2003 that smallpox again be made reportable through NNDSS and that all states, territories, and cities add smallpox to their lists of reportable diseases. In 2005, CSTE conducted a cross-sectional survey in the United States and its territories to assess key components for surveillance of suspected smallpox disease, including legal reporting requirements, laboratory testing, and training and education (e.g., oral presentations and guides). This report summarizes the results of that survey, which indicated that 100% had the capacity to receive and investigate reports, 94% of states had legal requirements to report suspected smallpox disease, 70% had mandatory laboratory reporting of results indicative of smallpox disease, and 68% were providing ongoing training and education of health-care providers and public health staff.     

Epidemiology of neonatal group B streptococcal disease in The Netherlands 1997-98

Group B streptococcal (GBS) infection is still an important cause of morbidity and mortality in newborn infants. In The Netherlands, there are no published data on the incidence of neonatal GBS infection. We collected data of all infants with GBS disease during the first 3 months of life, as reported to the Dutch Paediatric Surveillance Unit (DPSU) during a period of 2 years (1997-98). Neonates with early-onset GBS disease (both sepsis and probable sepsis) were included for further analysis. The level of completeness of the DPSU data was determined by capture-recapture techniques. The incidence of early-onset GBS disease in The Netherlands in 1997-98, as calculated from the DPSU data, was 0.9 per 1000 live births. After correction for under-reporting, the incidence was estimated to be 1.9 per 1000 live births. The case fatality rate of early-onset GBS disease was only 5%. Despite the decrease in the mortality rate during the last decades, it remains a serious condition with potential irreversible brain damage. Therefore, formal guidelines for the prevention of neonatal early-onset GBS disease in The Netherlands were introduced in 1999. The data collected in this study may serve as baseline data for evaluation of the effect of these guidelines.     

Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003

Limited information exists on the incidence and characteristics of invasive group A streptococcal (GAS) infections among residents of long-term care facilities (LTCFs). We reviewed cases of invasive GAS infections occurring among persons > or =65 years of age identified through active, population-based surveillance from 1998 through 2003. We identified 1,762 invasive GAS cases among persons > or =65 years, including 1,662 with known residence type (LTCF or community). Incidence of invasive GAS infection among LTCF residents compared to community-based elderly was 41.0 versus 6.9 cases per 100,000 population. LTCF case-patients were 1.5 times as likely to die from the infection as community-based case-patients (33% vs. 21%, p<0.01) but were less often hospitalized (90% vs. 95%, p<0.01). In multivariate logistic regression modeling, LTCF residence remained an independent predictor of death. Additional prevention strategies against GAS infection in this high-risk population are urgently needed.     

Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2003-2005

Arthritis is highly prevalent among U.S. adults, the leading cause of disability, and associated with substantial activity limitation, work disability, reduced quality of life, and high health-care costs. As the population ages, arthritis is expected to affect an estimated 67 million adults in the United States by 2030. This report updates estimates of the national prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation in the adult U.S. population, using data from the National Health Interview Survey (NHIS) for 2003-2005. The findings indicated that an estimated 21.6% of the adult U.S. population (46.4 million persons) had doctor-diagnosed arthritis, and 8.3% (17.4 million) had arthritis-attributable activity limitations. Public and private health agencies should promote measures to increase the availability of evidence-based arthritis prevention and management interventions.     

Invasive group a streptococcal disease in nursing homes, Minnesota, 1995-2006

Nursing home residents are at high risk for invasive group A streptococcal (GAS) disease, and clusters of cases in nursing homes are common.To characterize the epidemiologic features of invasive GAS disease in nursing homes, we conducted active, statewide, population- and laboratory-based surveillance in Minnesota from April 1995 through 2006. Of 1,858 invasive GAS disease cases, 134 (7%) occurred in nursing home residents; 34 of these cases were identified as part of 13 clusters. Recognizing cases of GAS disease in nursing homes posed challenges. Measures to ensure identification of case-patients as residents of specific nursing homes need to be included in standard guidelines for the prevention and control of invasive GAS disease in this setting.     

Pertussis--United States, 2001-2003

Pertussis is a highly contagious, vaccine-preventable bacterial illness characterized by paroxysmal cough, posttussive vomiting, and inspiratory whoop. Pertussis also can occur as a mild or moderate cough illness in persons who are partially immune. In the United States, most hospitalizations and nearly all deaths from pertussis are reported in infants aged <6 months, but substantial morbidity does occur in other age groups. Infant/childhood vaccination has contributed to a reduction of more than 90% in pertussis-related morbidity and mortality since the early 1940s in the United States. Estimates of childhood vaccination coverage with > or =3 doses of pertussis-containing vaccine have exceeded 90% since 1994; however, reported pertussis cases increased from a historic low of 1,010 in 1976 to 11,647 cases in 2003. A substantial increase in reported cases has occurred among adolescents, who become susceptible to pertussis approximately 6-10 years after childhood vaccination. Recently, booster vaccines for adolescents and adults combining pertussis antigens with tetanus and diphtheria toxoids (Tdap) were approved by the Food and Drug Administration (FDA). On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP) recommended Tdap for all persons aged 11-18 years. This report summarizes national surveillance data on pertussis reported to CDC during 2001-2003 and focuses on pertussis reported among persons aged 10-19 years before implementation of national recommendations for adolescent pertussis vaccination.     

Comparison of meningococcal disease surveillance systems - United States, 2005-2008

Meningococcal disease is a nationally notifiable disease caused by the bacterium Neisseria meningitidis. Rates of the disease have decreased since 2000 and are currently at a historic low. The National Notifiable Diseases Surveillance System (NNDSS) and Active Bacterial Core surveillance (ABCs) are the two surveillance systems in the United States that track cases of meningococcal disease. Whereas NNDSS (a passive surveillance system) covers all of the United States and records both probable and confirmed cases of meningococcal disease, ABCs (an active surveillance system) covers six states and portions of four other states and records only culture-confirmed cases. However, ABCs surveillance data are more detailed than NNDSS and are more widely used in vaccine policy and development. To determine whether ABCs estimates of the number of cases of meningococcal disease were far lower than NNDSS counts and the contribution of polymerase chain reaction (PCR) to that difference, CDC conducted an analysis to compare the two systems. CDC compared 1) the number of meningococcal disease cases reported by NNDSS in ABCs areas during 2005-2008 with the number reported by both systems and 2) the mean annual number of cases reported by NNDSS nationally during 2005-2008, with the mean projected national number from ABCs. The results of these two calculations indicated that 8.9% or 14.5% of meningococcal disease cases reported by NNDSS, respectively, were not reported by ABCs, most commonly because they were probable cases detected by PCR testing. Because ABCs data do not substantially underestimate the number of cases of meningococcal disease, implementing PCR testing for N. meningitidis in all ABCs reference laboratories likely would not increase estimates of disease greatly.     

Comparison of two prevention strategies for neonatal group B streptococcal disease

BACKGROUND: Neonatal group B streptococcal disease is a serious infection, causing more than 2,000 cases of sepsis annually. The Centers for Disease Control and Prevention has recommended two alternative strategies to prevent infection, but few data directly compare the two in terms of intrapartum antibiotic administration, protocol feasibility, newborn laboratory evaluation, and costs. METHODS: We collected data on intrapartum antibiotic administration, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay for 347 mother-infant pairs in a family practice residency maternity service. During the first study period, laboring women were managed under the screening strategy, and during the second study period, laboring women were managed under the risk factor strategy. RESULTS: Of those women who qualified for antibiotic prophylaxis, only 28% of women in the screening group and 47% of women in the risk factor group actually received the recommended two or more doses of intrapartum antibiotics. Ninety-one percent of women in the screening group had prenatal cultures done appropriately. Newborns in the screening group had an increased risk of having a complete blood count (OR = 1.35, 95% CI 1.01, 1.80). There was no difference between groups in maternal or newborn length of stay. CONCLUSIONS: A minority of laboring women in either strategy received the recommended doses of intrapartum antibiotics. Feasibility of obtaining prenatal screening cultures is high. Although newborn laboratory testing increased with the screening strategy, overall costs and length of stay were comparable.