236171 Using hospitalization data to evaluate and improve invasive pneumococcal disease surveillance New Mexico, 20072009

Tuesday, November 1, 2011: 2:50 PM

Mam Ibraheem, MD, MPH , CDC, New Mexico Department of Health/Epidemiology and Response Division, Santa Fe, NM
Michael Landen, MD, MPH , Epidemiology and Response Division, New Mexico Department of Health, Santa Fe, NM
Background: Invasive pneumococcal disease (IPD) is vaccine-preventable and commonly manifests as septicemia or meningitis. IPD underreporting can influence policy decisions regarding vaccine use.

Objective: We evaluated reporting completeness and how hospitalization data can benefit surveillance.

Methods: Combined IPD data from passive surveillance and Emerging Infections Program Active Bacterial Core surveillance during 20072009 were linked with Hospital Inpatient Discharge Data (HIDD). Potential IPD cases in HIDD were identified by using two IPD-specific ICD-9 codes (meningitis or septicemia caused by Streptococcus pneumoniae) and three nonspecific codes. For potential cases identified only through HIDD, laboratory reports confirming S. pneumoniae isolation from normally sterile sites were reviewed for all those with IPD-specific codes and a systematic sample of 17% of those with nonspecific codes. Capture-recapture was used to estimate surveillance sensitivity.

Results: Surveillance detected 1,191 cases, 396 initially through active surveillance. HIDD identified 1,287 potential cases; 558 cases were identified by both HIDD and surveillance. Of 729 potential cases identified only by HIDD, 104 had IPD-specific and 625 had IPD-nonspecific codes; 32 were true IPD cases. We estimated 36 additional cases missed by both sources, yielding 95% overall system sensitivity. Predictive value positive was 78% for IPD-specific codes and 30% for nonspecific codes.

Conclusions: The high sensitivity of New Mexico IPD surveillance is likely because of combined active and passive surveillance. Hospitalization data yielded additional IPD cases not identified through surveillance. For states that rely on passive reporting, using IPD-specific ICD-9 codes from hospitalization data might be an efficient way to improve surveillance.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
-Explain the importance of invasive pneumococcal disease (IPD) reporting completeness. -Describe the application of capture-recapture methods for disease monitoring. -Demonstrate how hospitalization data can benefit IPD surveillance.

Keywords: Surveillance, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am currently an Epidemic Intelligence Service (EIS) officer with the Centers for Disease Control and Prevention (CDC). In addition, I am a physician, epidemiologist, and an outstanding Fulbright alumnus. I got my MD degree with merit in 2003 and my MPH degree with distinction in 2010. I worked as a research assistant for many NIH funded projects during my MPH study. In addition, I attended and presented in many national/local scientific conferences to fulfill my Fulbright scholarship requirements.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.