Delaware to outsource newborn screenings while ramping up STD testing

SMYRNA, Delaware —Delaware's Division of Public Health will outsource newborn baby screenings and ramp up its sexually transmitted infections lab to help battle an increasing number of cases that are harder to fight because of antibiotic resistance.

Every newborn baby in Delaware gets a heel stick to draw blood to be tested for 47 conditions, including cystic fibrosis and thyroid disease. By fall, the routine tests are expected to be done by a lab other than the division lab in Smyrna, where they have been done for half a century.

The STI lab will draw from clinics and hospitals all over the state, as well as from high school wellness centers that are authorized by parents to swab the private areas of teenage boys and girls in case of symptoms. 

The new lab will allow the state to put more time and money than it does now into examining venereal diseases, which are infections transmitted through sex and caused by bacteria, viruses or parasites. Research shows gonorrhea is a particular issue in Delaware, which worries health officials because some strains are resistant to antibiotics. 

"We have very high rates of STIs and we don't know exactly why," said Dr. Karyl Rattay, director of the Division of Public Health.

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Delaware was one of the first states to require newborn blood tests, said Jelili Ojodu, director of newborn screening and genetics for the Association of Public Health Laboratories. The program is almost 55 years old. 

But today, he said, it’s increasingly common for smaller U.S. states to outsource the tests.

Two specimens are taken from each of the 12,000 Delaware babies born each year, resulting in the lab processing more than 25,000 specimens a year, said Dr. Sergio Huerta, state health lab director. 

“These are not easy diseases to test for," Huerta said. "Even though we have the staff and expertise, it’s a cost decision.”

Huerta said he couldn't say specifically how much the testing and lab costs, but it's millions of dollars for testing, equipment, and personnel. 

The instruments to test for newborn diseases are pricey— sometimes half a million to a million dollars —  and new tests are requiring even more expensive instrumentation, he said.

Rattay said the tests now cost $135 per baby, up from $78 in 2006. The state conducted a cost analysis last year for the newborn screenings and realized the cost will have to rise to $185 almost immediately in order to conduct all of the needed tests, Rattay said.

It's cheaper and as effective to outsource the work to another institution that already an infrastructure in place, Rattay and Huerta said.

"We have these huge corporations out there that have the equipment already and are using them," Huerta said.

"The focus all along has been and continues to be what's in the best interest of these babies," Rattay said. "We were concerned that... we weren't going to have the program we needed."

State officials declined to say what company they are negotiating with, but expect contracts to be signed soon and an announcement to be made.  

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Huerta said the newborn screening staff will be added to the microbiology lab to test for and study venereal diseases.

The state now tests for sexually transmitted illnesses to determine how often STIs are popping up and if certain infections are evolving in the state, Huerta said. He estimates the lab performs 40,000 venereal tests a year. The new lab will expand the scope of what it's doing and look at trends and other facets of infection.

Last fall, the Centers for Disease Control and Prevention found there were more STIs reported in the U.S. in 2015 than ever before.

Since 2009, Delaware has ranked in the top 20 for chlamydia rates in the country. It's the most commonly reported STI in The First State and throughout the U.S.

In 2015, Delaware had the 15th highest rate in the country for chlamydia and 13th highest for gonorrhea, according to the CDC's most recent data. 

STIs are rising most dramatically among Delaware teenagers aged 14 to 17, state health officials say. Young adults in Delaware tend to be more sexually active than other U.S. teenagers, Rattay said.

Sussex County has seen a higher rate of STIs in recent years, she said. In 2016, that county made up about 19 percent of the chlamydia cases, according to data provided by the Division of Public Health. 

Debra Rutledge, a state lab manager, said the lab receives samples from hospitals, colleges, Planned Parenthood, Westside Health Care, state clinics, detention centers and high school health centers.

Those School Based Health Centers in Delaware public high schools are not the same thing as a routine school nurse office. The centers are set up with federal and state grants and staffed by nurses from nearby hospitals, not the school system. 

In order to perform any of the wellness center's wide-ranging services, parents must sign a consent form at the start of the school year, said Sharon-rose Gargula, president of the Delaware School Nurse Association.

Many of the centers, but not all, are set up to allow a nurse who thinks a student is showing symptoms of a sexually transmitted disease to swab the student's genital areas. Those samples are sent to test by the state.

Delaware has 29 School Based Health Centers, but not all high schools have one yet.

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Typically, a student exhibiting symptoms will go to the nurse's office and the nurse will then refer the student to the wellness center, Gargula said.

Finding sexually transmitted illnesses quickly helps the patient and society because the illness can be treated and will not be passed on.

Chlamydia, gonorrhea, and syphilis are typically curable with antibiotics, but these infections tend to go undiagnosed for a while and are becoming more difficult to treat, according to Delaware health officials say.

Gonorrhea has developed the strongest resistance to antibiotics. The World Health Organization updated its treatment guidelines for these infections last year due to the prevalence of antibiotic-resistance diseases. 

Rattay described these type of infections as a "huge public health concern." The state has already seen a high percentage of gonorrhea cases that are not easily treated with antibiotics.

While some public health officials have said that STIs are rising partly because of the opioid addiction epidemic, Huerta and others say the biggest problem is that people are overusing or misusing antibiotics.

Many people don't realize not using the medication correctly, which includes not finished the entire course of pills — or giving some of your pills to someone else — could be more damaging than helpful. 

"It's something we're going to pay a lot of attention to in the future," Huerta said. "It's amazing how susceptible human beings are."

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.