Sir,

Ophthalmia neonatorum is conjunctival infection within the first 28 days of life and is commonly used to refer to those cases caused by Neisseria gonorrhoeae or Chlamydia trachomatis. Ophthalmia neonatorum is a notifiable disease in England and Wales. The public health actions that should follow notification are designed to reduce the morbidity associated with ophthalmia neonatorum and prevent further spread of infection. Statutory notifications have reduced markedly over the past decade (Table 1).1

Table 1 Number of reported cases of ophthalmia neonatorum in England and Wales by year (1998–2006)
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In Leeds (West Yorkshire, UK) the number of notifications to the Local Authority has also been in decline (Figure 1).2

Figure 1
figure 1

Total cases of ophthalmia neonatorum in Leeds from 1997 to 2008 by year.

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Case report

To address the question of compliance with notification we compared the number of cases notified with the number of eye swabs positive for N. gonorrhoeae or C. trachomatis in children ⩽28 days between January 2006 and March 2008.

The number of eye swabs submitted in each year were 153, 123, and 38 respectively.

Table 2 shows the number of positive laboratory findings and cases reported to the HPA. This confirms that there is underreporting of ophthalmia neonatorum in Leeds.

Table 2 Number of positive laboratory samples and cases reported/unreported (2006–2008)
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There are four possible explanations for the decline in notification of cases of ophthalmia neonatorum: (i) the incidence of neonatal conjunctivitis is falling; (ii) there is failure to notify positive cases; (iii) possible cases are not being sampled adequately; or (iv) the detection methods used in the laboratory are inadequate.

Comment

We have shown that there is under notification of ophthalmia neonatorum. It is the responsibility of the referring clinician to report cases of suspected ophthalmia neonatorum, which should be done on clinical grounds, with the laboratory test used as a welcome confirmation of the diagnosis. To improve reporting rates all positive swab reports have had an ‘autocomment’ added reminding the clinician of their duty to report the case to the HPA. Underreporting of ophthalmia neonatorum has implications for national monitoring and for limiting the morbidity of the condition for patients, mothers, and the community at large. We would welcome similar studies on a national basis to determine how widespread a problem this may be.