National Center for Health Research, October 9th 2018
Thank you for the opportunity to express our views on the USPSTF Draft Recommendation Statement for Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum. The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work.
Our major concern is that the updated recommendation relies on the data outlined in the 1996 guidelines, but those data are not publicly available on the AHRQ website or elsewhere on the web. An “A” rating should be supported by solid, readily available studies. Without them, it is impossible for experts to accurately comment on this draft statement.
In addition, the draft statement does not adequately explain why the USPSTF is continuing to recommend allocating resources towards universal prophylaxis of all neonates while countries like Canada, Denmark, Sweden and the UK have stopped universal ocular prophylaxis for all neonates. In fact, as USPSTF noted, “Canada discontinued national surveillance of neonatal ophthalmia in 2000 due to low incidence.” It is not difficult to identify which mothers have not had adequate prenatal care to ensure screening for gonorrhea, and it would certainly make sense to err on the side of caution if the evidence of screening was ambiguous. We expect that would still be well below half of neonates in the U.S. The draft statement does not provide any data that support universal ocular prophylaxis rather than prophylaxis for neonates born to women with inadequate prenatal care to ensure screening.
In order for the U.S. to follow in the footsteps of Canada and other countries that have stopped universal prophylaxis, we recommend that USPSTF encourage physicians to have conversations or conduct counselling on STD’s and give pregnant mothers the option to opt out of neonatal prophylaxis. Women in the U.S. who do not have adequate prenatal care or who are unsure if they have gonorrhea should have their children treated with the ocular prophylaxis. Nationwide, the need for ocular prophylaxis would be lessened by improving access to gonorrhea screening as part of comprehensive, quality prenatal care. Improving access to such care should be a top priority and would reduce the need for universal ocular prophylaxis.
For questions or more information, please contact Dr.Varuna Srinivasan, MBBS MPH at vs@center4research.org or at (202) 223-4000.