Challenges in congenital syphilis surveillance: how are congenital syphilis investigations classified?
BACKGROUND
Congenital syphilis is a serious, preventable, and nationally notifiable disease. Despite the existence of a surveillance case definition, congenital syphilis is sometimes classified differently using an algorithm on the Centers for Disease Control and Prevention's case reporting form.


METHODS
We reviewed Louisiana's congenital syphilis electronic reporting system for investigations of infants born from January 2010 to October 2011, abstracted data required for classification, and applied the surveillance definition and the algorithm. We calculated the sensitivities and specificities of the algorithm and Louisiana's classification using the surveillance definition as the surveillance gold standard.


RESULTS
Among 349 congenital syphilis investigations, the surveillance definition identified 62 cases. The algorithm had a sensitivity of 91.9% and a specificity of 64.1%. Louisiana's classification had a sensitivity of 50% and a specificity of 91.3% compared with the surveillance definition.


CONCLUSIONS
The differences between the algorithm and the surveillance definition led to misclassification of congenital syphilis cases. The algorithm should match the surveillance definition. Other state and local health departments should assure that their reported cases meet the surveillance definition.
Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA. vie4@cdc.gov
Camille E
CE
Introcaso
DeAnn
D
Gruber
Heather
H
Bradley
Thomas A
TA
Peterman
Joy
J
Ewell
Debbie
D
Wendell
Joseph
J
Foxhood
John R
JR
Su
Hillard S
HS
Weinstock
Lauri E
LE
Markowitz
D000465:Algorithms; D002487:Centers for Disease Control and Prevention, U.S.; D006801:Humans; D007223:Infant; D008145:Louisiana; D011159:Population Surveillance / Q000379:methods*; D012680:Sensitivity and Specificity; D013590:Syphilis, Congenital / Q000145:classification*; D014481:United States