Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States
Antonia Kwan, Roshini S Abraham, Robert Currier, Amy Brower, Karen Andruszewski, Jordan K Abbott, Mei Baker, Mark Ballow, Louis E Bartoshesky, Francisco A Bonilla, Charles Brokopp, Edward Brooks, Michele Caggana, Jocelyn Celestin, Joseph A Church, Anne Marie Comeau, James A Connelly, Morton J Cowan, Charlotte Cunningham-Rundles, Trivikram Dasu, Nina Dave, Maria T De La Morena, Ulrich Duffner, Chin-To Fong, Lisa Forbes, Debra Freedenberg, Erwin W Gelfand, Jaime E Hale, I Celine Hanson, Beverly N Hay, Diana Hu, Anthony Infante, Daisy Johnson, Neena Kapoor, Denise M Kay, Donald B Kohn, Rachel Lee, Heather Lehman, Zhili Lin, Fred Lorey, Aly Abdel-Mageed, Adrienne Manning, Sean McGhee, Theodore B Moore, Stanley J Naides, Luigi D Notarangelo, Jordan S Orange, Sung-Yun Pai, Matthew Porteus, Ray Rodriguez, Neil Romberg, John Routes, Mary Ruehle, Arye Rubenstein, Carlos A Saavedra-Matiz, Ginger Scott, Patricia M Scott, Elizabeth Secord, Christine Seroogy, William T Shearer, Subhadra Siegel, Stacy K Silvers, E Richard Stiehm, Robert W Sugerman, John L Sullivan, Susan Tanksley, Millard L Tierce 4th, James Verbsky, Beth Vogel, Rosalyn Walker, Kelly Walkovich, Jolan E Walter, Richard L Wasserman, Michael S Watson, Geoffrey A Weinberg, Leonard B Weiner, Heather Wood, Anne B Yates, Jennifer M Puck, Vincent R Bonagura, Antonia Kwan, Roshini S Abraham, Robert Currier, Amy Brower, Karen Andruszewski, Jordan K Abbott, Mei Baker, Mark Ballow, Louis E Bartoshesky, Francisco A Bonilla, Charles Brokopp, Edward Brooks, Michele Caggana, Jocelyn Celestin, Joseph A Church, Anne Marie Comeau, James A Connelly, Morton J Cowan, Charlotte Cunningham-Rundles, Trivikram Dasu, Nina Dave, Maria T De La Morena, Ulrich Duffner, Chin-To Fong, Lisa Forbes, Debra Freedenberg, Erwin W Gelfand, Jaime E Hale, I Celine Hanson, Beverly N Hay, Diana Hu, Anthony Infante, Daisy Johnson, Neena Kapoor, Denise M Kay, Donald B Kohn, Rachel Lee, Heather Lehman, Zhili Lin, Fred Lorey, Aly Abdel-Mageed, Adrienne Manning, Sean McGhee, Theodore B Moore, Stanley J Naides, Luigi D Notarangelo, Jordan S Orange, Sung-Yun Pai, Matthew Porteus, Ray Rodriguez, Neil Romberg, John Routes, Mary Ruehle, Arye Rubenstein, Carlos A Saavedra-Matiz, Ginger Scott, Patricia M Scott, Elizabeth Secord, Christine Seroogy, William T Shearer, Subhadra Siegel, Stacy K Silvers, E Richard Stiehm, Robert W Sugerman, John L Sullivan, Susan Tanksley, Millard L Tierce 4th, James Verbsky, Beth Vogel, Rosalyn Walker, Kelly Walkovich, Jolan E Walter, Richard L Wasserman, Michael S Watson, Geoffrey A Weinberg, Leonard B Weiner, Heather Wood, Anne B Yates, Jennifer M Puck, Vincent R Bonagura
Abstract
Importance: Newborn screening for severe combined immunodeficiency (SCID) using assays to detect T-cell receptor excision circles (TRECs) began in Wisconsin in 2008, and SCID was added to the national recommended uniform panel for newborn screened disorders in 2010. Currently 23 states, the District of Columbia, and the Navajo Nation conduct population-wide newborn screening for SCID. The incidence of SCID is estimated at 1 in 100,000 births.
Objectives: To present data from a spectrum of SCID newborn screening programs, establish population-based incidence for SCID and other conditions with T-cell lymphopenia, and document early institution of effective treatments.
Design: Epidemiological and retrospective observational study.
Setting: Representatives in states conducting SCID newborn screening were invited to submit their SCID screening algorithms, test performance data, and deidentified clinical and laboratory information regarding infants screened and cases with nonnormal results. Infants born from the start of each participating program from January 2008 through the most recent evaluable date prior to July 2013 were included. Representatives from 10 states plus the Navajo Area Indian Health Service contributed data from 3,030,083 newborns screened with a TREC test.
Main outcomes and measures: Infants with SCID and other diagnoses of T-cell lymphopenia were classified. Incidence and, where possible, etiologies were determined. Interventions and survival were tracked.
Results: Screening detected 52 cases of typical SCID, leaky SCID, and Omenn syndrome, affecting 1 in 58,000 infants (95% CI, 1/46,000-1/80,000). Survival of SCID-affected infants through their diagnosis and immune reconstitution was 87% (45/52), 92% (45/49) for infants who received transplantation, enzyme replacement, and/or gene therapy. Additional interventions for SCID and non-SCID T-cell lymphopenia included immunoglobulin infusions, preventive antibiotics, and avoidance of live vaccines. Variations in definitions and follow-up practices influenced the rates of detection of non-SCID T-cell lymphopenia.
Conclusions and relevance: Newborn screening in 11 programs in the United States identified SCID in 1 in 58,000 infants, with high survival. The usefulness of detection of non-SCID T-cell lymphopenias by the same screening remains to be determined.
Conflict of interest statement
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Bonagura reported receiving grants from the Jeffrey Modell Foundation, Baxter Pharmaceuticals, and New York State; serving on a committee for CSL-Behring; and serving on an advisory board for Baxter Pharmaceuticals. No other disclosures were reported.
Source: PubMed