Investigation of a Cluster of Neural Tube Defects — Central Washington, 2010–2013

During August 2012, a health-care provider in central Washington alerted the Washington State Department of Health (DOH) about an excessive number of anencephaly births at a local hospital. After examining referral patterns for high-risk pregnancies in central Washington, DOH identified pregnancies affected by a severe neural tube defect (NTD) in a three-county area. Case findings included a review of area prevalence of anencephaly was not determined. DOH recommended reminding doctors about the importance of folic acid supplementation for women of childbearing age, and monitoring private well nitrate concentrations because of their potential association with birth defects and other adverse health outcomes.