Assessment of De-Duplication Methods for Gonorrhea and Chlamydia Case Reports Emily Weston, MPH 2016 Annual CSTE Meeting Tip of the Infectious Disease Surveillance Disease Iceberg: Surveillance/Informatics Rapid Fire Tuesday, June 21, 2016 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

Methods In 2015, STD surveillance programs completed an assessment of current surveillance practices Reporting practices were reviewed for de-duplication of cases of chlamydia and gonorrhea separately, including: the time period used to decide when a second positive test should be reported as a case AND the method of de-duplication (e.g., automatic or manual)

Why did we ask about these surveillance practices? Chlamydia and gonorrhea are the 2 most commonly reported conditions in the US Both can be diagnosed with highly sensitive nucleic acid amplification tests (NAATs) No guidance from CDC on the minimum amount of time between positive laboratory test results and when to report a new infection

Results 93% (54/58) of jurisdictions provided valid responses for the de-duplication questions Reported time period for de-duplication of case data varied by jurisdiction and by pathogen Sites reported a range (7-90 days) for de-duplication of gonorrhea and chlamydia case report data Majority of jurisdictions reported using 30 days 31/54 (57%) jurisdictions for chlamydia 29/54 (54%) jurisdictions for gonorrhea

Results Two jurisdictions had additional de-duplication rules for certain populations different time periods for pregnant women and 30 days from treatment Six jurisdictions reported different time periods for when de-duplication is performed for gonorrhea and chlamydia Jurisdiction Chlamydia De-duplication time frame (in days) Gonorrhea De-duplication time frame (in days) Baltimore 30 15 Hawaii 60 Massachusetts 28 14 Minnesota 21 Individually reviewed Virginia Washington 7

Results Jurisdictions were asked to describe de-duplication for the following at their jurisdiction: Same test from multiple reporting sources (e.g., laboratory report and provider report) Multiple tests diagnosing same infection (e.g., 2 laboratory reports on the same person in 1 week) De-duplication methods varied across jurisdictions (n=54) De-duplication method Same test from multiple sources/reports Multiple tests diagnosing the same infection Automatic 26% 28% Manual 24% 20% Combination 31% 22% Undeterminable

Outcomes Presented data to jurisdictions on quarterly CSTE call Proposed algorithm for de-duplicating chlamydia and gonorrhea cases to jurisdictions

Is there evidence of re-infection*? De-Duplication Methods Algorithm Is there evidence of a prior infection that has already been reported as a case? No Report as a new case Yes Did the previously reported infection have: • a specimen collection date in the prior 30 days OR • a documented treatment date in the prior 30 days No Report as a new case Yes Is there evidence of re-infection*? No De-duplicate laboratory report and do not report as a case Yes Report as a new case *Evidence of reinfection will require examination into various sources at each jurisdiction (e.g., partner services and management of partners, investigation into completion of antibiotic treatment)

Conclusions Surveillance assessment allowed insight into current practices of jurisdictions regarding an important surveillance ‘best practice’ topic (i.e., de-duplicating cases) Means and time period for de-duplication of cases varied by jurisdiction and by pathogen Range 7-90 days; majority of jurisdictions use 30 days To assist with performance, training, and improve surveillance practices, we proposed a standard timeframe in which cases should be de-duplicated Developed website link for jurisdictions to reference tools for de-duplicating cases

Acknowledgements Elizabeth Torrone, PhD Hillard Weinstock, MD, MPH Surveillance and Data Management Branch Team Members CSTE Jurisdictions

References Workowski KA, Bolan GA. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR 2015;64(No. RR 3): 1-137. Papp JR, Schachter J, Gaydos CA, Van der Pol B. Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. MMWR 2014;63(No. RR-2):1-19. Council of State and Territorial Epidemiologists (CSTE). Update to Public Health Reporting and National Notification for Gonorrhea. 13-ID-03. Atlanta: CSTE; 2013. Available from: http://www.cste.org. Council of State and Territorial Epidemiologists (CSTE). Public Health Reporting and National Notification for Infection Caused by Chlamydia trachomatis. 09-ID-08. Atlanta: CSTE; 2009. Available from: http://www.cste.org. Gaydos CA, Crotchfelt KA, Howell MR, Kralian S, Hauptman P, Quinn TC. Molecular amplification assays to detect chlamydial infections in urine specimens from high school female students and to monitor the persistance of chlamydial DNA after therapy. J Infect Dis 1998;177:417–24. Workowski KA, Lampe MF, Wong KG, Watts MB, Stamm WE. Long-term eradication of Chlamydia trachomatis genital infection after antimicrobial therapy. JAMA 1993;270:2071–5. Bachmann LH, Desmond RA, Stephens J, Hughes A, Hook EW III. Duration of persistence of gonococcal DNA detected by ligase chain reaction in men and women following recommended therapy for uncomplicated gonorrhea. J Clin Microbiol 2002;40:3596–601.

Questions? csi7@cdc.gov For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention