Georgia epidemiology report, Vol. 21, no. 1 (Jan. 2005)

January 2005

volume 21 number 01

January is Birth Defects Prevention Month
...but any month is the month to prevent birth defects.

Birth defects are abnormal structural or functional/metabolic conditions that are present at birth. Some are mild, like an extra finger or toe. Some are very serious, like a heart defect. They can cause physical, mental, or medical problems. Some birth defects are caused by genetic factors like Down syndrome or sickle cell anemia. Others are caused by certain drugs, medicines, or chemicals. The causes of most birth defects are still unknown. Researchers are working hard to learn the causes of birth defects so we can find ways to prevent them. *
About 120,000 babies are born with birth defects each year in the United States. The overall prevalence and incidence of birth defects in Georgia is currently unknown. However, based on data from Vital Records and the Metropolitan Atlanta Congenital Defects Program (MACDP), it is estimated that approximately 3,000-3,500 children with birth defects are born each year in Georgia.
The good news is that new ways of preventing and treating birth defects are being found. Genes that may cause birth defects are being discovered, providing hope for new treatments and cures.

Genetic counseling can provide parents with information about their risks based on family history, age, ethnic or racial background, or other factors. Better health care for mothers with problems like diabetes or seizures can improve their chances of having healthy babies. In addition, immunization prevents infections like German measles (rubella) that can harm unborn babies.*
Did You Know? Birth defects are the leading cause of death in children
less than one year of age--causing one in every five deaths. 18 babies die each day in the U.S. as the result of a birth defect. Defects of the heart and limbs are the most common kinds of birth defects Millions of dollars are spent every year to care for and treat children with birth defects.*
*Source: National Birth Defects Prevention Network (NBDPN) pamphlet: Important Information about Preventing Birth Defects

The Georgia Birth Defects Reporting and Information System (GBDRIS)

The Georgia Birth Defects Reporting and Information System (GBDRIS) is a statewide surveillance system designed to provide information on the epidemiology of birth defects including incidence, prevalence, and trends. The GBDRIS collects information on children from birth to six years of age. The system relies on existing data as well as hospital, laboratory and provider reporting. The GBDRIS is maintained by the Maternal and Child Health (MCH) Section of the Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources.
The initial pilot phase of the GBDRIS was conducted in 2003. The pilot project involved 15 hospitals and medical centers. The two hospitals with the highest number of births from each of the six perinatal regions in Georgia were selected. In addition, the Regional Perinatal Centers were included if they were not one of the top two birthing hospitals. Each of the six Regional Perinatal Centers provide care for high-risk pregnant women and infants, and they train staff from other hospitals in perinatal care, especially for high risk patients.

Birth defects reporting forms were collected monthly from pilot sites. These data were merged with other existing data sets and records were deduplicated to create one summary record for each child. Table 1 shows the rates of specific birth defects for births in 2003 based on the data reported by the pilot sites. These data represent suspected cases of the birth defect in question. The MCH Epidemiology Section did not confirm the diagnoses.
In 2004, the GBDRIS pilot project was expanded to include additional hospitals throughout the state. A summary report of the 2004 findings will be created upon completion of the first quarter of 2005. All birthing hospitals have now been contacted regarding the guidelines for reporting birth defects. As of November 1, over 60 hospitals have begun reporting monthly. Our goal is to have consistent monthly reporting by nearly every birthing hospital in Georgia beginning in 2005.

The Georgia Epidemiology Report Via E-Mail
To better serve our readers, we would like to know if you would prefer to receive the GER by e-mail as a readable PDF file starting in 2004. If yes, please send your name and e-mail address to Gaepinfo@dhr.state.ga.us.

Georgia is fortunate to be the site of the Centers for Disease Excerpt from Folic Acid and the Prevention of Birth Defects:

Control and Prevention's Metropolitan Atlanta Congenital De- A National Survey of Pre-Pregnancy Awareness and Behavior

fects Program (MACDP). MACDP has been a unique source Among Women of Childbearing Age 1995-2004 (Report No.

of data nationwide for multiple etiologic studies, for baseline 31-1897-04) conducted by the Gallup Organization.

comparison of birth defects rates in other areas, and for studies

on the impact of prenatal diagnoses on birth defects preva- In 1992, the U.S. Public Health Service (PHS) recommended that

lence. MACDP is considered the gold standard for birth de- all women capable of becoming pregnant consume 400 micro-

fects surveillance systems so we will be using it to evaluate the grams (mcg) of the B vitamin folic acid per day to reduce the risk

quality of the data collected through the GBDRIS. A summary of neural tube defects occurring during pregnancy. In 1995, the

of this evaluation will be posted on our website later this year. March of Dimes Birth Defects Foundation (MOD) received fund-

ing from the Centers for Disease Control and Prevention to con-

The GBDRIS Reporting Manual, reporting guidelines, and re- duct a benchmark survey of women of childbearing age to assess

porting forms can be found on the MCH Epidemiology's Birth their knowledge and behaviors relative to daily consumption of

Defects web page under GBDRIS/Publications (http:// folic acid. The survey found relatively low awareness of folic acid

h e a l t h . s t a t e . g a . u s / e p i / m c h / b i r t h d e f e c t s / g b d r i s / and the PHS recommendation, suggesting the need for educational

publications.asp). The Birth Defects web page also provides strategies to inform more women about the benefits of folic acid.

general information about birth defects along with frequently Since 1995, the MOD and other agencies have conducted public

asked questions and fact sheets for specific defects (http:// education campaigns to inform women of childbearing age about

health.state.ga.us/epi/mch/birthdefects/index.asp).

the benefits of consuming folic acid every day beginning before

pregnancy.

Questions related to the GBDRIS can be sent to

GBDRIS@dhr.state.ga.us.

Since the 1995 survey, the MOD has commissioned The Gallup

Organization to conduct seven follow-up surveys to measure any

changes that may have occurred since 1995 in women's awareness

and behavior relative to folic acid and other pre-pregnancy

Table 1: Birth Defects Rates (per 10,000 live births)** (Based on 2003 GBDRIS Pilot Project data)

health issues. These surveys serve as rough measures of effectiveness of the educational campaigns designated to increase awareness of folic acid among women of childbearing age.

Birth Defect Frequency Rate

Atrial septal defect 342

70.55 Highlights from the 2004 Gallup Survey:

Cleft lip with and without cleft palate 22

Cleft palate without cleft lip

8

Coarctation of aorta 21

Diaphragmatic hernia

9

Down syndrome 56

Encephalocele

6

4.54 1.65 4.33 1.86 11.55 1.24

The 2004 survey results confirm that improvements have been made in folic acid awareness and knowledge since 1995, and while reported folic acid intake still remains relatively low, it has increased. Currently, four in ten (40%) women between the ages of 18-45 report that they take a vitamin containing folic acid daily, the highest level recorded since the benchmark study of 1995.

Esophageal atresia/tracheoesophageal fistula

7

Gastroschisis or omphalocele 35

Hirshsprungs disease 10

1.44 7.22
2.06

Of women who were not pregnant at the time of the 2004 survey, 37 percent report taking a vitamin containing folic acid daily.

Hydrocephalus without spina bifida 41 Hypoplastic left heart syndrome 10 Hypospadias and epispadias 111

8.46 2.06
22.90

Of all women surveyed in 2004, those least likely to consume a vitamin containing folic acid daily include women:

Obstructive genitourinary defect 85 Pulmonary valve atresia and stenosis 68
Pyloric stenosis 16 Rectal and large intestinal atresia/stenosis 22
Renal agenesis/hypoplasia 10 Spina bifida without anencephalus 24
Tetralogy of Fallot 12 Transposition of great arteries 10
Trisomy 18 14

17.54 14.03 3.30 4.54 2.06 4.95 2.48 2.06 2.89

- 18-24 years (31% compared with 46% for those 25-
45 years).
- Who have not attended college (29% compared with
48% among women who have attended college).
- With annual household incomes under $25,000 (30%
compared with 46% for those with incomes of $50,000 or more).
- Who are non-white women 18-45 years of age (31%
compared to 43% among 18-45 year old white women).

Ventricular septal defect 218 **Select defects with five or more cases are shown

44.97 -2 -

- Residing in the South (35% compared to 41% in the East
and Midwest and 44% among women in the West) As in 2003, the majority (89%) of women in the 2004 survey
who did not currently take any vitamins or mineral supplements
Articles written by Debra L. Hersh, M.P.H.

daily said they would be likely to take a daily multi-vitamin if advised to do so by their physician or other health care provider, including 54% who said they would be very likely.

National Folic Acid Awareness Week

January 24th-30th, 2005 might be just another busy week to some, but, for those women who learn about the benefit of taking folic acid each day, that week could mean the world to their babies.

achievement is a good reason to celebrate, we must not forget the 3,000 or more babies who will still be born this year with these life-ending or life-threatening birth defects. Public policy has played an important role; it's now our time to do the rest!

The Georgia Folic Acid Coalition, along with other members of the National Council on Folic Acid, has designated January 2430, 2005 as the first National Folic Acid Awareness Week. In honor of this week, we'd like to remind you that you can play an important role in sharing the folic acid message with your patients, clients, coworkers, friends, and family. As you know, folic acid is a B vitamin that can help prevent up to 70% of serious birth defects like spina bifida and anencephaly when taken daily before becoming pregnant and during pregnancy. Sadly, many women in Georgia don't know that! For example, 65% of women enrolled in WIC and family planning clinics in three Georgia Health Districts from 2001-2004 were unaware of the benefits of folic acid. They didn't know that taking a daily multivitamin containing folic acid or eating a serving of breakfast cereal fortified with 100% of the Daily Value of folic acid (400 micrograms) each day before pregnancy in addition to a healthy diet can help prevent a serious birth defect in a baby they might have in the future.1
You can help! Research shows that women listen to the advice of their health care providers. Taking just a few seconds to encourage a woman of childbearing age to take a daily multivitamin or eat fully fortified cereals each day as part of a healthy diet, regardless of their pregnancy intent, could make all the difference for the baby she might have in the future.
National Folic Acid Awareness Week is a time to renew our dedication to preventing birth defects as well as a time to celebrate successes! In the past year, research showed that the mandatory fortification of cereal grain products with folic acid has helped to ensure that 1,000 more babies will be born each year in the U.S. without anencephaly or spina bifida.2 While this public health

Georgia especially needs your efforts. Data show that the annual rates of spina bifida and anencephaly in the metropolitan Atlanta area are still higher than the national average. As the rates of NTDs per 10,000 births decreased by 26% nationwide because of fortification of enriched grain foods with folic acid beginning in 1998, metropolitan Atlanta area rates fell only about 20%.3 With your effort and the efforts of others in Georgia communities, we can work together to be a model for other states and help protect hundreds more babies. Start today! Encourage every woman you know to make sure she is getting enough folic acid every single day. It's easy, just one multivitamin or a serving of fully fortified breakfast cereal each day as a part of a healthy diet is all women need to be certain they're getting enough folic acid!
To learn how to be a part of National Folic Acid Awareness week activities in Georgia, contact Elizabeth Fassett, Communications and Professional Education Committee Chair, Georgia Folic Acid Coalition, at eff8@cdc.gov. To find out more about folic acid and preventing birth defects, visit: www.cdc.gov/folicacid Find free information and patient education materials online at: http://www2.cdc.gov/ncbddd/faorder
1. Emory Georgia Folic Acid Campaign Surveys 2001 2004 (unpublished data, Emory).
2. CDC. Spina bifida and anencephaly before and after folic acid mandate United States, 1995 1996 and 1999 2000. MMWR 2004; 53: 362 365.
3. CDC Metropolitan Atlanta Congenital Defects Program. 2004 (unpublished data, CDC).
This article written by The Georgia Folic Acid Coalition

Division of Public Health http://health.state.ga.us
Kathleen E. Toomey, M.D., M.P.H. Director
State Health Officer

Epidemiology Branch http://health.state.ga.us/epi
Paul A. Blake, M.D., M.P.H. Director
State Epidemiologist
Mel Ralston Public Health Advisor

Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. Editor
Kathryn E. Arnold, M.D. Paul A. Blake, M.D., M.P.H. Susan Lance-Parker, D.V.M., Ph.D. Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
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Division of Public Health Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588 Fax: (404) 657-7517

Georgia Department of Human Resources

Please send comments to: Gaepinfo@dhr.state.ga.us

The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

PRESORTED STANDARD U.S. POSTAGE
PAID ATLANTA, GA PERMIT NO. 4528

January 2005

Volume 21 Number 01

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for October 2004

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for October 2004
2004 37 1946 19 4 63 888 3 14 52 2 0 1 1 0 0 201 66 1 3 5 11 0 28

Previous 3 Months Total

Ending October

2002 198

2003 166

2004 157

9345

9499

7255

42

33

84

9

9

4

304

276

220

5157

4782

3328

13

20

13

105

390

86

104

207

141

10

12

6

2

0

1

5

6

4

0

2

2

8

9

4

0

0

0

817

860

752

664

230

156

28

38

5

111

117

38

201

161

27

196

234

69

3

0

1

144

138

85

Previous 12 Months Total

Ending in October

2002 625

2003 674

2004 555

34522

36278

31803

124

115

199

48

31

23

907

868

808

19008

18035

14406

97

82

107

522

804

377

449

686

605

18

35

38

5

10

13

40

31

24

3

3

2

29

32

26

0

0

1

1957

2020

1977

1757

1509

659

111

122

97

321

455

341

743

757

334

789

867

542

16

11

3

599

522

505

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

AIDS Profile Update

Report Period
Latest 12 Months: 01/04-12/04 Five Years Ago: 01/00-12/00 Cumulative: 07/81-12/04

Total Cases Reported* <13yrs >=13yrs Total

4

1,548 1,552

10

1,123 1,133

219

27,770 27,989

Percent Female
26.3
28.1
19.0

Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown

33.3

6.4

2.3

12.3

1.6

44.2

31.1

11.8

2.8

19.5

2.5

32.2

45.8

16.2

5.0

14.3

1.9

16.7

Race Distribution (%) White Black Other

21.1 76.5

2.4

19.2 76.8

4.1

32.2 65.2

2.6

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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