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Congenital Syphilis Epidemiology, Impact and Interventions

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  • 1. Congenital Syphilis: Epidemiology, Impact and Interventions Ed Weckerly, Epidemiologist Sydney Minnerly, Syphilis Elimination Coordinator
  • 2. What is Congenital Syphilis?
    • A pregnant woman infected with syphilis may transmit the infection to the fetus
    • If untreated, congenital syphilis may lead to:
      • Stillbirth
      • Neonatal death
      • Deafness
      • Neurologic impairment
      • Bone deformities
  • 3. Congenital Syphilis Surveillance
    • Case Definitions
      • No Case
      • Presumptive Case
      • Confirmed Case
      • Stillbirth
    • Fill out the Congenital Report Form
    • Enter into STD*MIS
  • 4. Primary and Secondary Syphilis Cases: Texas, 1971-2009
  • 5. National Comparison (P&S Syphilis)
    • In 2008
      • 1,405 cases (5.9 per 100,000 - 10 th highest)
      • 10% of the 13,500 cases in the U.S.
      • U.S. rate was 4.5 (CDC 2008 Surveillance Report: http://www.cdc.gov/std/stats08/tables/24.htm)
    • In 2009
      • 1,644 cases in Texas (6.6 per 100,000)
  • 6. P&S Syphilis Case Rates by County: Texas, 2009
  • 7. P&S Syphilis Case Rates by Race/Ethnicity: Texas, 1998-2009
  • 8. P&S Syphilis Case Rates by Year of Report and Sex: Texas, 1998-2009 Female Male
  • 9. P&S Syphilis Cases by Sex and MSM: Texas, 2002-2009
  • 10. Congenital Syphilis Cases: Texas, 1991-2009
  • 11. Congenital Syphilis Case Rates* by Year of Report: Texas, 2000-2009 *CS cases per 100,000 live births. 2007-2008 live birth totals were unavailable so the 2006 total was used for the calculation.
  • 12. National Comparisons (Congenital Syphilis)
    • In 2008
      • 124 cases (31 per 100,000 - 2 nd highest)
      • 29% of the 431 cases in the U.S.
      • U.S. rate was 10 (CDC 2008 Surveillance Report http://www.cdc.gov/std/stats08/tables/39.htm)
    • In 2009
      • 124 cases in Texas (31 per 100,000)
      • 32% of the 385 cases in the U.S. (provisional)
  • 13. Congenital Syphilis Case Rates* by County: Texas, 2009 *CS cases per 100,000 live births. 2006 live birth numbers were used for the calculation as more recent data were unavailable.
  • 14. Congenital Syphilis Cases by County: Texas, 2009
  • 15. P&S Syphilis Case Rates and Congenital Syphilis Cases by County: Texas, 2009
  • 16. Congenital Syphilis Cases by Year and County: Texas, 2000-2009
  • 17. What are the Chances?
    • The number of congenital syphilis cases in a given year has been closely tied to the number of P&S syphilis cases in women in the preceding year…
  • 18. Congenital Syphilis Cases and Female P&S Syphilis Case Rates by Year: Texas, 2000-2009
  • 19. Congenital Syphilis Cases per 100 Female P&S Syphilis Cases: Texas, 2000-2009 * CS cases per 100 P&S cases among females in the preceding year
  • 20. Congenital Syphilis Case Rates* by Year of Report and Race: Texas, 2000-2009 *CS cases per 100,000 live births. 2007-2008 live birth totals were unavailable so the 2006 total was used for the calculation.
  • 21. Texas Congenital Syphilis Cases and General Population Births by Vital Status of Child 2009 Cases 2006 General Population
  • 22. Texas Congenital Syphilis Cases and General Population Births by Race 2009 Cases 2006 General Population
  • 23. Texas Congenital Syphilis Cases and General Population Births by Maternal Prenatal Care 2009 Cases 2006 General Population
  • 24. Texas Congenital Syphilis Cases and General Population Births by Number of Prenatal Visits 2009 Cases 2005 General Population
  • 25. Syphilis Testing and Treatment During Pregnancy for Texas Congenital Cases 2009 Cases
  • 26. What is being done in Texas?
    • Working on a comprehensive statewide congenital plan
      • Our goal is to reduce the number of congenital cases in Texas by 25% within 5 years
      • Target activities involve the following areas:
        • Surveillance
        • Programmatic
        • Providers/Clinical Settings/Services
        • Promotion and Awareness
  • 27. Surveillance Activities
    • Map primary, secondary and congenital cases by county
    • Review congenital cases in real time
    • Increase accessibility to testing and treatment history
    • Improve reporting accuracy by programs
  • 28. Programmatic Activities
    • Target high-risk populations through prevention programs
    • Revise Program Operating Procedures for working congenital cases
    • Reach out to other programs which work with pregnant women
  • 29. Providers/Clinical Services
    • Promote awareness to providers in high-morbidity areas
    • Present to Perinatal HIV Consortium
    • Recommend 3 rd trimester testing in high-morbidity/high-risk populations
    • Ensure all pregnant women who test positive for any STD are also tested for syphilis
    • Monitor treatment options used for women who present as allergic to penicillin
    • Evaluate desensitization policies of programs
  • 30. Promotion and Awareness
    • Stomp Out Syphilis campaign
    • Develop congenital syphilis brochure
    • Develop and post congenital FAQ sheet
    • Continue congenital meetings
    • Develop training for contractors
    • Ensure pregnant women are accessing prenatal
    • Posted one page summary of law changes
    • Add 3 rd trimester testing module to perinatal training for providers
  • 31. Conclusion
    • Texas is at a turning point in addressing congenital syphilis cases
    • Continue to address racial and socio-economic disparities
    • Requires the collaboration of many entities