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GBS, Pertussis in Latin America

Division of Bacterial Diseases (DBD) News Bulletin

Spring 2013

Preventing GBS through Electronic Platforms

Despite more than a decade of prevention efforts, group B Streptococcus (GBS) remains the leading cause of early-onset neonatal sepsis in the US. The most recent Guidelines for Prevention of Perinatal GBS Disease were published in 2010 and were endorsed by the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American College of Nurse-Midwives, American Academy of Family Physicians, and American Society for Microbiology. The cornerstones of GBS prevention are prenatal screening of all pregnant women for GBS colonization, giving appropriate intrapartum antibiotic prophylaxis (IAP) to GBS-colonized women and to those with specific risk-factors, and appropriately managing neonates at high risk for early onset group B streptococcal (EOGBS) disease.

Team members at National Conference on Health Communication, Marketing and Media

NCIRD OD’s Maureen Marshall and DBD’s Alison Patti and Jonathan Wortham presented a poster about the GBS app’s development at the 2012 National Conference on Health Communication, Marketing, and Media.

Implementation assessments of the GBS guidelines have found several areas where implementation is less than ideal, including suboptimal antibiotic choices for IAP for penicillin-allergic women and suboptimal implementation of IAP for women in preterm labor. Few evaluations have focused on implementation of the GBS guidelines for neonatal care. However, a public health evaluation project on hospital policies related to the evaluation and management of neonates at risk for EOGBS disease recently undertaken by the Respiratory Diseases Branch (RDB) showed that more than half of the hospitals surveyed had policies that were not consistent with CDC GBS guidelines.

While the GBS guidelines—as well as complementary algorithms, slide sets, and frequently asked questions—are available on the website, providers need to determine which algorithm(s) are relevant for a patient, obtain the necessary information, and then proceed through 36 pages of text and 8 tables and figures to obtain the correct clinical management for prevention of EOGBS disease. To improve implementation of the 2010 GBS guidelines, RDB, with programming and strategic support from NCIRD’s web team, has developed a smartphone application called “Prevent GBS” that gives obstetric and neonatal providers specific, evidence-based management recommendations after responding to on-screen prompts for the relevant clinical information. EISO Jonathan Wortham explains that, “This project aims to provide clinicians with customized, evidence-based management recommendations for each patient at the bedside, simplifying guideline implementation and ultimately preventing cases of GBS disease.”

The app will be available both on the CDC mobile website (optimized for smartphones and PDAs), and as a CDC stand-alone native application that can be run directly from an iPad, iPhone, or Android device without an internet connection. The app is in its final stages of development and is expected to go live during summer 2013.

While “Prevent GBS” will be available on multiple platforms, we are unlikely to reach providers who are not actively searching for information on the GBS guidelines. Integration of the GBS guidelines into electronic health records (EHR) would allow use of patient clinical information to prompt clinicians to implement recommendations at the point of care while simultaneously reaching all providers using the EHR. Ideally, EHR integration will involve key clinical data elements triggering the “Prevent GBS” app, which would analyze the data received and send back the appropriate guidance to the provider within the EHR system. The EHR system would then display those recommendations to the user for seamless implementation of the guidance in real time. Development of EHR integration is currently underway with piloting set to occur at a hospital system in Pennsylvania by the end of 2013.

LAPP Chile Efforts

Pertussis Surveillance Strategy session

PAHO, CDC, Chilean National Institute for Public Health, and Chile’s Ministry of Health officials discuss pertussis surveillance strategies at the Ministry of Health. MVPDB’s Matt Griffith (second from left) and Lucia Tondella (third from right) participated in this meeting.

The Latin American Pertussis Project (LAPP), a collaboration between the Sabin Vaccine Institute, the Pan American Health Organization (PAHO), MVPDB, and the Latin American Ministries of Health, works to strengthen pertussis surveillance and more accurately describe the epidemiology and burden of disease in Latin America. The project’s specific objectives are to develop standards and practices for pertussis surveillance and strengthen laboratory capacity to detect Bordetella pertussis in participating countries. In-country assessment of the pertussis surveillance system and laboratory capacity, in-country laboratory diagnostic training (PCR, culture, and serology), implementation of a laboratory quality control and quality assurance program, and ongoing technical assistance are among the activities being undertaken to accomplish LAPP’s objectives.

Since 2009, Argentina, Mexico, Panama, and Colombia have participated in LAPP. Chile is the most recent country to join LAPP. Lucia Tondella and Brunie Burgos from MVPDB’s Pertussis Laboratory and Matt Griffith from the branch’s epidemiology team conducted an assessment of Chile’s pertussis surveillance system and pertussis laboratory capacity between January 28 and February 7, 2013. The team met with national, regional, and local officials and visited health centers, hospitals, and laboratories in 3 provinces, including Santiago. A follow-up trip to provide laboratory diagnostic training took place in April.

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