Louisiana Department of Health, STD/HIV Program, New Orleans, LA.
Sex Transm Dis. 2019 Feb;46(2):139-142. doi: 10.1097/OLQ.0000000000000909.
Louisiana has had the highest rates of congenital syphilis (CS) in the nation since 2012. Congenital syphilis case review boards were established statewide in 2016 to study CS cases and identify interventions.
We summarized the findings of CS review boards, assessed which cases were preventable by prenatal care providers, reviewed recommended interventions, and assessed subsequent improvement in provider practices.
All 79 CS cases reported from January 2016 to July 2017 were reviewed by boards during August 2016 to August 2017. Twenty-six (33%) cases that could have been prevented by prenatal care providers had: lack of rescreening at 28 to 32 weeks (n = 15), lack of any screening (n = 5), treatment delay (n = 4), or incorrect interpretation of test results (n = 2). Twenty-one (27%) cases were possibly preventable by providers including: mother did not return for follow-up and treatment (n = 19), late third trimester reactive test with premature delivery (n = 1), or incomplete treatment and lack of follow-up by health department staff (n = 1). Thirty-two (40%) cases that were unlikely to be prevented by providers had: nonreactive test at 28-32 weeks then reactive test <30 days before delivery (n = 10), no prenatal care (n = 9), mother adequately treated, case by infant criteria (n = 8), first/second trimester nonreactive, reactive at preterm delivery (n = 4), or mother adequately treated, reinfected before delivery (n = 1). Providers were advised to adhere to CDC recommended syphilis screening and treatment protocols and rapidly report pregnant women with syphilis. Many providers changed their procedures.
Congenital syphilis case review boards identified practices with inadequate screening, treatment, or reporting. Sharing these findings with providers changed practices and may prevent future cases.
自 2012 年以来，路易斯安那州一直是全美先天性梅毒（CS）发病率最高的州。2016 年，全州范围内成立了先天性梅毒病例审查委员会，以研究 CS 病例并确定干预措施。
我们总结了 CS 审查委员会的调查结果，评估了哪些病例可由产前护理提供者预防，审查了推荐的干预措施，并评估了随后提供者做法的改进情况。
2016 年 8 月至 2017 年 7 月期间，所有 79 例 CS 病例均由委员会审查。26 例（33%）本可通过产前护理提供者预防：28-32 周时未进行重新筛查（n=15），未进行任何筛查（n=5），治疗延迟（n=4），或对检测结果的错误解读（n=2）。21 例（27%）病例可能因提供者原因而预防：母亲未返回进行随访和治疗（n=19），妊娠晚期出现反应性检测且早产（n=1），或卫生部门工作人员治疗不完整且随访不充分（n=1）。32 例（40%）病例不太可能因提供者而预防：28-32 周时检测为阴性，然后在分娩前 30 天内检测为阳性（n=10），无产前护理（n=9），母亲按婴儿标准充分治疗（n=8），第一/第二孕期检测为阴性，早产时检测为阳性（n=4），或母亲充分治疗，但在分娩前再次感染（n=1）。建议提供者遵守 CDC 推荐的梅毒筛查和治疗方案，并迅速报告患有梅毒的孕妇。许多提供者改变了他们的程序。
先天性梅毒病例审查委员会发现了筛查、治疗或报告不足的做法。与提供者分享这些发现改变了做法，可能预防了未来的病例。
