Zika

NBIC is charged with enhancing the capability of the Federal Government to enable early warning and shared situational awareness of acute biological events to support better decisions through rapid identification, characterization, localization, and tracking. A key aspect of this mission is the requirement to integrate and collaborate with federal and, state, local, tribal, and territorial (SLTT) government agencies. NBIC develops and disseminates a variety of products to its stakeholders, including daily reports, ad-hoc reports, analytic collaborations, and leadership briefings upon request. Stakeholders interact with and utilize NBIC’s products in different ways, depending on the mission and jurisdiction involved. Specific collaborations with individual stakeholders are most frequent and evident during major infectious disease events, such as the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders PHEIC. Collaborative efforts and known outcomes among varying levels of government are described in detail below in order to highlight NBIC’s integration focus and capabilities in this role.

Objective:

An important part of the National Biosurveillance Integration Center’s (NBIC) mission is collaboration with federal, state, local, tribal, and territorial governments for the purpose of enhancing early warning, shared situational awareness, and related decision support for infectious disease events. Several such collaborations occurred at multiple jurisdictional levels during the recent Zika epidemic in the Americas and the associated microcephaly and other neurological disorders Public Health Event of International Concern (PHEIC). The collaborations and their known outcomes from this major infectious disease event are described below, and NBIC stands ready to support similar efforts for future events.

As a part of the Zika Birth Defects Surveillance, a national effort coordinated by the Centers for Disease Control and Prevention (CDC), NYC is conducting enhanced surveillance of all births with defects included in the congenital Zika syndrome (CZS) phenotype among infants born in NYC beginning in 2016. The intent of the project is to provide background on the prevalence of these conditions, regardless of cause. The surveillance project builds on the New York State (NYS) Congenital Malformations Registry, a passive, mandatory reporting system that relies on reporting from hospitals and providers. For the Surveillance project, potential cases of Zika-related birth defects (ZBD) are identified by hospital and administrative data of birth records with one or more of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes associated with CZS.1 The list of included diagnostic codes was specified by the NYS registry following guidance established by CDC. Full medical record chart abstraction of the birth hospital visit of potential cases is then conducted applying further inclusion guidelines to identify ZBD cases. Recent reports of late presentation of birth defects consistent with CZS suggest that some cases are being missed due to identification and diagnosis of the condition after birth.2 As one component of a broader strategy to obtain a more accurate surveillance count, we seek to identify potential ZBD cases first diagnosed in the 6-month postpartum period using Medicaid claims data.

Objective:

To assess the use of Medicaid claims data to conduct surveillance for cases of Zika-related birth defects identified after birth among infants born in New York City (NYC).