Congenital syphilis case investigation and reporting form instructions
Corporate Authors:National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.). Division of STD Prevention.
Description:Instructions -- The Congenital Syphilis Case Investigation and Reporting Form -- Quality assurance -- Publications -- General instructions -- Appendix: Surveillance case definition for congenital syphilis.
Note: These instructions accompany the Congenital Syphilis Case Investigation and Reporting Form, CDC 73.126, REV. 02-2013.
This reporting form is authorized by law (Public Health Service Act, 42 USC 241, OMB Approval No. 0920-0128). Reporting of congenital syphilis cases using this form is required of all sexually transmitted disease (STD) project areas receiving STD grant funds from the Centers for Disease Control and Prevention (CDC).
Reported cases of congenital syphilis (CS) before 1989 were defined and classified on the basis of a complex set of clinical and serologic features known as the Kaufman criteria. These criteria were developed to help clinicians evaluate the likelihood that an infant or a child had CS. The need for clinical criteria came from the lack of a widely available “gold standard” test to confirm the diagnosis of CS. Serologic tests for syphilis (STS) alone are not useful for diagnosis. The Kaufman criteria, however, were not designed for use as a surveillance case definition.
CDC developed a surveillance case definition for CS in 1988 (subsequently revised in 1996). This surveillance case definition differs from the clinical diagnosis of congenital syphilis in several important ways. All infants born to mothers who have untreated or inadequately treated syphilis are considered potentially infected. (This criterion is based on the 70%-100% chance that during the first 4 years of infection, an untreated woman will transmit syphilis to her unborn baby.*) Asymptomatic infants and stillbirths are included in the case definition. The surveillance case definition makes case classification simpler, making comparisons across states and regions more reliable. Also, longitudinal follow-up is not required to determine the appropriate case classification, so reporting can occur in the immediate post-delivery period.
Another important feature of the surveillance case definition is its emphasis on the mother’s history of diagnosis, treatment, and follow-up. The cases defined by this surveillance case definition give program planners information on how to improve the STD prevention and prenatal care systems to identify and treat pregnant women who have syphilis. Having CS surveillance data available to program planners and managers improves our ability to reach high risk women and treat their syphilis infections early in pregnancy. The increased sensitivity of the surveillance case definition can classify infants as cases who are not infected with syphilis, reflecting the limitations of current diagnostic tests. Inclusion of these infants in the surveillance system is accepted, however, because they help identify problems in the prevention of CS. Nonetheless, the most recent revisions to the CS case report Form 126 were made with the intent of having reported cases more closely reflect the surveillance case definition.
This form (CDC 73.126 REV. 02-2013) should be used by health officials who are responsible for identifying the infants or children of recently pregnant women who may be infected with Treponema pallidum. The accompanying algorithms (found on the back of the reporting form) are provided to assist in determining how a case of CS should be classified for reporting purposes. The surveillance case definition remains the “gold standard” for CS case classification. The surveillance case definition (appendix) should be used to classify cases into one of the following three surveillance categories: confirmed, probable, or syphilitic stillbirth.
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