Minnesota Department of Health (MDH) Bug Bytes
April 13, 2004
Vol. 5: No. 4
1. Perinatal GBS Disease Prevention
Despite a decline in incidence, group B streptococcus (GBS) remains the leading cause of invasive bacterial infection in newborns in the U.S. GBS in newborns can be reduced through diagnosis of maternal colonization and administration of intrapartum antibiotic prophylaxis (IAP) during labor and delivery. In August 2002, revised guidelines for the prevention of perinatal GBS disease were published by CDC and recommends GBS screening of all pregnant women. As part of our Emerging Infections Program (EIP) we set out to determine the extent to which providers follow current policies regarding perinatal GBS disease prevention and to compare changes in provider practice from 1998 to 2002.
In 2002, all licensed obstetricians, a 20% random sample of family practice physicians, and all nurse midwives who work in prenatal care settings in Minnesota were asked to complete a two-page questionnaire. A similar survey was conducted in 1998. In 2002, all providers surveyed indicated they had adopted a policy for the prevention of perinatal GBS disease. Among these providers, 97% reported that their policy was based upon a published guideline compared with only 84% of providers reported using published guidelines in 1998. Providers reporting the use of a screening-based approach increased significantly from 1998 to 2002 (obstetricians, 36% to 90%; nurse midwives, 13% to 72%; family practice physicians, 42% to 83%). When risk-based providers were asked if they were planning to implement the new universal screening-based approach, 52% of midwives, 50% of family practice physicians, and 32% of obstetricians indicated they planned to do so.
The results of our survey suggest that prenatal care providers have adopted policies for the prevention of perinatal GBS disease and that a large majority follow established, published guidelines. Since 1998, the use of a screening-based strategy for GBS prevention has increased significantly. Moreover, almost half of the providers who had not adopted a screening-based strategy indicated they were planning to do so in the near future.
Providers should be educated about the current recommendations for perinatal GBS disease prevention. We will continue to monitor the incidence of GBS disease among infants and prenatal screening of women, and the monitor the use of IAP for GBS-positive women during labor and delivery.
CDC's revised guidelines for the prevention of perinatal GBS disease
can be found at:
2. Knowledge About Toxoplasma gondii Among
Pregnant Women in Minnesota
Infection with Toxoplasma gondii is one of the most clinically significant foodborne diseases in pregnant women; congenital toxoplasmosis is an important cause of blindness, deafness, and mental retardation. In the U.S., up to 85% of women of childbearing age are susceptible to T. gondii. Up to 50% of T. gondii infections are due to ingestion of undercooked meat; transmission may also occur through contact with Toxoplasma oocysts excreted by felines. In 2003, we surveyed Minnesota pregnant women in outpatient settings, focusing on knowledge of T. gondii transmission and risk factors as well as preventive behavior during pregnancy.
We received 322 completed surveys from pregnant women aged 15 to 42 years old. The majority of respondents were white (84%), non-Hispanic (89%), and U.S. born (95%). 134 (42%) had heard about toxoplasmosis, of these; 89 (66%) heard about it from a medical professional, 84 (63%) from magazines on childbirth, and 47 (35%) from friends and family. When asked specifically about the risk factors for T. gondii infection, 200 (62%) knew you could get toxoplasmosis from changing cat litter, but only 74 (24%) knew you could get it from eating undercooked pork and 84 (26%) by gardening without gloves. Similarly, 184 (57%) respondents knew T. gondii is shed in the feces of cats, but only 84 (26%) knew it could be found in raw or undercooked meat. Most of the respondents reported very good hand hygiene; 229 (71%) routinely wash their hands after changing cat litter, 262 (81%) after gardening, and 300 (93%) after handling raw meat. Higher education levels (college versus high school graduate) were significantly associated with having heard of toxoplasmosis, as well as knowing the risk associated with changing cat litter and eating undercooked pork. There were no significant differences in knowledge levels by age, race or trimester.
Prenatal care providers are a key source of toxoplasmosis prevention
information for pregnant women and are encouraged to routinely provide
specific information including the risk associated with food-borne toxoplasmosis
to their pregnant patients. To this end, we have developed a brochure
entitled 'Toxoplasmosis: An Important Message'. Copies of the brochure
can be requested by calling (612) 676-5414 (toll free, 1-877-676-5414)
or downloaded in PDF from http://www.health.state.mn.us/divs/idepc/diseases
/toxoplasmosis/index.html. Toxoplasmosis is a reportable disease; clinicians should call the same number listed to report cases including those with only serological evidence of infection.
3. Foodborne Illness Primer for Physicians
It is estimated that 76 million people get sick, more than 300,000 are hospitalized, and 5,000 die as a result of foodborne illnesses annually in the U.S. Due to changes in American dietary habits and the food production, processing, and distribution industry, many foodborne pathogens are considered emerging pathogens.
To help increase awareness of foodborne illnesses among physicians, nurses and other healthcare providers a new edition of Diagnosis and Management of Foodborne Illness: A Primer for Physicians and Other Health Care Professionals has been released. The primer was produced collaboratively by the American Medical Association (AMA), the American Nurses Association (ANA), the Centers for Disease Control and Prevention (CDC), the Center for Food Safety and Applied Nutrition-Food and Drug Administration (CFSAN-FDA), and the Food Safety and Inspection Service (FSIS) of the United Sates Department of Agriculture. This primer is intended to provide health care professionals with current and accurate information for the diagnosis, treatment and reporting of foodborne illnesses. The primer also provides health care professionals with patient education materials on prevention of foodborne illness. The primer offers Continuing Medical Education credit for physicians, nurses, or health care educators.
A PDF version of the primer is at http://www.ama-assn.org/ama/pub/category/3629.html.
4. New FoodNet Publications
One component of our Emerging Infections Program is the Foodborne Diseases Active Surveillance Network (FoodNet), a collaborative network that now includes 11 sites across the country. We have been a member of FoodNet since it's inception in 1995. Some of the findings from the first few years (primarily 1996-99) of FoodNet have just been published as 26 articles in the April 15, 2004 supplement issue of Clinical Infectious Diseases, available at: http://www.journals.uchicago.edu/CID/journal/contents/v38nS3.html.
The issue contains articles on: incidence trends for selected bacterial foodborne pathogens (E. coli O157:H7, Campylobacter, Salmonella, and Shigella); results of case-control studies that document risk factors for infections with E. coli O157:H7, Salmonella, and Campylobacter, including antimicrobial-resistant strains of the latter two pathogens; burden of illness due to foodborne pathogens; laboratory and physician practices regarding foodborne diseases; and more.
Our substantial contribution to these publications represents a prodigious
effort over the years put forth by Minnesota's infection control professionals,
laboratorians, health care providers, and others who comprise our surveillance
network. Thank you! Questions on any of the articles or their implication
can be directed to the Acute Disease Investigation and Control Section,
Foodborne Diseases Unit at (612) 676-5414.
Bug Bytes is a combined effort of the Infectious Disease Epidemiology, Prevention and Control Division and the Public Health Laboratory Division of MDH. We provide Bug Bytes as a way to say THANK YOU to the infection control professionals, laboratorians, local public health professionals, and health care providers who assist us.
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