Transcript Weston_CSTE Deduplication presentation for upload_06-10

Assessment of De-Duplication
Methods for Gonorrhea and
Chlamydia Case Reports
Emily Weston, MPH
2016 Annual CSTE Meeting
Tip of the Infectious Disease Surveillance Disease Iceberg:
Surveillance/Informatics Rapid Fire
Tuesday, June 21, 2016
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of STD Prevention
Methods

In 2015, STD surveillance programs completed an
assessment of current surveillance practices

Reporting practices were reviewed for de-duplication of
cases of chlamydia and gonorrhea separately, including:
• the time period used to decide when a second positive test should
be reported as a case AND
• the method of de-duplication (e.g., automatic or manual)
Why did we ask about these surveillance practices?

Chlamydia and gonorrhea are the 2 most commonly
reported conditions in the US

Both can be diagnosed with highly sensitive nucleic acid
amplification tests (NAATs)

No guidance from CDC on the minimum amount of time
between positive laboratory test results and when to report
a new infection
Results

93% (54/58) of jurisdictions provided valid responses for the
de-duplication questions

Reported time period for de-duplication of case data varied
by jurisdiction and by pathogen

Sites reported a range (7-90 days) for de-duplication of
gonorrhea and chlamydia case report data

Majority of jurisdictions reported using 30 days
• 31/54 (57%) jurisdictions for chlamydia
• 29/54 (54%) jurisdictions for gonorrhea
Results

Two jurisdictions had additional de-duplication rules for
certain populations
• different time periods for pregnant women and 30 days from
treatment

Six jurisdictions reported different time periods for when deduplication is performed for gonorrhea and chlamydia
Jurisdiction
Chlamydia De-duplication
time frame (in days)
Gonorrhea Deduplication time frame
(in days)
Baltimore
30
15
Hawaii
30
60
Massachusetts
28
14
Minnesota
21
Individually reviewed
Virginia
21
14
Washington
21
7
Results

Jurisdictions were asked to describe de-duplication for the
following at their jurisdiction:
• Same test from multiple reporting sources (e.g., laboratory report
and provider report)
• Multiple tests diagnosing same infection (e.g., 2 laboratory reports
on the same person in 1 week)

De-duplication methods varied across jurisdictions (n=54)
De-duplication
method
Same test from multiple
sources/reports
Multiple tests
diagnosing the same
infection
Automatic
26%
28%
Manual
24%
20%
Combination
31%
22%
Undeterminable
22%
31%
Outcomes

Presented data to jurisdictions on quarterly CSTE call

Proposed algorithm for de-duplicating chlamydia and
gonorrhea cases to jurisdictions
De-Duplication Methods Algorithm
Is there evidence of a prior
infection that has already been
reported as a case?
Yes
No
Report as a new case
Did the previously reported infection have:
• a specimen collection date in the prior 30 days OR
• a documented treatment date in the prior 30 days
Yes
No
Report as a new case
No
Is there evidence of re-infection*?
De-duplicate laboratory
report and
do not report as a case
Yes
*Evidence of reinfection will require
examination into various sources at each
jurisdiction (e.g., partner services and
management of partners, investigation into
completion of antibiotic treatment)
Report as a new case
Conclusions


Surveillance assessment allowed insight into current
practices of jurisdictions regarding an important surveillance
‘best practice’ topic (i.e., de-duplicating cases)
Means and time period for de-duplication of cases varied by
jurisdiction and by pathogen
• Range 7-90 days; majority of jurisdictions use 30 days


To assist with performance, training, and improve
surveillance practices, we proposed a standard timeframe in
which cases should be de-duplicated
Developed website link for jurisdictions to reference tools
for de-duplicating cases
Acknowledgements
• Elizabeth Torrone, PhD
• Hillard Weinstock, MD, MPH
• Surveillance and Data Management
Branch Team Members
• CSTE Jurisdictions
References
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Workowski KA, Bolan GA. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR
2015;64(No. RR 3): 1-137.
Papp JR, Schachter J, Gaydos CA, Van der Pol B. Recommendations for the Laboratory-Based
Detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. MMWR 2014;63(No. RR2):1-19.
Council of State and Territorial Epidemiologists (CSTE). Update to Public Health Reporting and
National Notification for Gonorrhea. 13-ID-03. Atlanta: CSTE; 2013. Available from:
http://www.cste.org.
Council of State and Territorial Epidemiologists (CSTE). Public Health Reporting and National
Notification for Infection Caused by Chlamydia trachomatis. 09-ID-08. Atlanta: CSTE; 2009.
Available from: http://www.cste.org.
Gaydos CA, Crotchfelt KA, Howell MR, Kralian S, Hauptman P, Quinn TC. Molecular amplification
assays to detect chlamydial infections in urine specimens from high school female students and
to monitor the persistance of chlamydial DNA after therapy. J Infect Dis 1998;177:417–24.
Workowski KA, Lampe MF, Wong KG, Watts MB, Stamm WE. Long-term eradication of Chlamydia
trachomatis genital infection after antimicrobial therapy. JAMA 1993;270:2071–5.
Bachmann LH, Desmond RA, Stephens J, Hughes A, Hook EW III. Duration of persistence of
gonococcal DNA detected by ligase chain reaction in men and women following recommended
therapy for uncomplicated gonorrhea. J Clin Microbiol 2002;40:3596–601.
Questions?
[email protected]
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of STD Prevention