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Wednesday, May 10, 2006 - 10:30 AM
229

Estimating the incidence of neonatal herpes infection in New York City, 1994-2003; implications for formulating a national case definition

Julia A. Schillinger1, Ellen Klingler2, Preeti Pathela3, Anna Battat2, Hwa-Gan Chang4, Eric Friedenberg2, Bonnie Kerker2, Perry Smith4, and Susan Blank1. (1) Bureau of Sexually Transmitted Disease Control, NYC DOHMH / Division of STD Prevention, CDC, 125 Worth St., Room 207, CN-73, New York, NY, USA, (2) New York City Department of Health and Mental Hygiene, New York, NY, USA, (3) STD Control, New York City Department of Health & Mental Hygiene, 125 Worth Street, Room 207, CN 73, New York, NY, USA, (4) New York State Department of Health, Albany, NY, USA


Background:
Published estimates of neonatal herpes (NH) incidence range from 11-31/100,000 live births. NH is not a reportable condition in New York City (NYC).

Objective:
To estimate annual NH incidence in NYC using a herpes-specific International Classification of Diseases (ICD) code, and proportion of infection attributable to herpes among neonates with a non-specific ICD code for congenital infections.

Method:
We used a statewide database of inpatient hospitalizations to identify infants aged <6 weeks at admission, discharged from a NYC hospital 1994-2003. NH cases were defined as infants discharged with a herpes-specific ICD code (ICD-054). Hospital discharge summaries and laboratory data were for all infants with ICD-054 and a sample of infants with ICD-771.2. (25% of those admitted on date of birth, 100% infants admitted after date of birth). Positive HSV PCR, Culture, DFA, or Tzanck preps were considered diagnostic. Annual number live births was obtained from NYC Vital Statistics.

Result:
A total of 169 infants (84 male, 85 female) were discharged with ICD-054 during the study period (range 9-22 per year); the average annual incidence of NH in NYC was 13.4/100,000 (range, 7.2 – 17.5/100,000) Of 169 requested ICD-054 discharge summaries, 76% (128) were received; only 36% (46/128) had laboratory-confirmed herpes infection. Among 117 infants coded as ICD-771.2 only, 10 (8.5%) infants had laboratory-confirmed herpes infection (2 female, 8 male) which extrapolates to 13 cases in ten years.

Conclusion:
NH incidence will be underestimated if only ICD-054 is considered. A substantial proportion of cases with NH diagnosis lack laboratory-confirmed infection. NH should be a reportable condition in NYC to permit accurate and reliable monitoring of this serious, and treatable infection.

Implications:
Regional and national estimates of NH incidence will be greatly impacted by whether or not laboratory confirmation is required for case definition. An ICD code specific for NH would make case ascertainment more straightforward.

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