Williams Laura J, Honein Margaret A, Rasmussen Sonja A
National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, MS F-45, Atlanta, GA 30345, USA.
Teratology. 2002;66 Suppl 1:S50-8. doi: 10.1002/tera.90011.
Few resources are available to guide public health officials in investigations of reported birth defects clusters. The majority of published resources focus on the investigation of cancer and infectious disease clusters and do not address clinical and epidemiologic concerns specific to birth defects research. This document aims to address these concerns, discuss the needs of the affected community, and provide suggestions for the development of a standardized protocol to be used as a guide in the investigation of birth defects clusters. We suggest that health departments and birth defects registries that may receive reports of birth defects clusters establish a protocol for responding that includes the following steps: develop a proactive plan for future birth defects cluster reports (step I), receive report of a birth defects cluster (step II), verify diagnoses and complete case ascertainment (step III), compare the observed rate to a reference rate (step IV), ascertain exposures among cases from available records (step V), interview case mothers (step VI), initiate further epidemiologic study-selection of controls (step VII), and communicate results to the community (step VIII). Specific criteria for continuing or terminating an investigation should be established before receiving cluster reports. The recommendations in this report should be carefully considered to ensure that the specific needs of the region, agency and affected community are met.
在对所报告的出生缺陷聚集性病例进行调查时，可供公共卫生官员参考的资源很少。大多数已发表的资源都集中在癌症和传染病聚集性病例的调查上，没有涉及出生缺陷研究特有的临床和流行病学问题。本文旨在解决这些问题，讨论受影响社区的需求，并为制定标准化方案提供建议，以便在出生缺陷聚集性病例调查中作为指导。我们建议，可能收到出生缺陷聚集性病例报告的卫生部门和出生缺陷登记机构制定一份应对方案，包括以下步骤：为未来的出生缺陷聚集性病例报告制定积极计划（第一步），接收出生缺陷聚集性病例报告（第二步），核实诊断并完成病例确定（第三步），将观察到的发病率与参考发病率进行比较（第四步），从现有记录中确定病例的暴露情况（第五步），访谈病例母亲（第六步），启动进一步的流行病学研究——选择对照（第七步），以及向社区通报结果（第八步）。在收到聚集性病例报告之前，应制定继续或终止调查的具体标准。本报告中的建议应仔细考虑，以确保满足该地区、机构和受影响社区的特定需求。
