The document summarizes Hamilton County's ongoing syphilis epidemic. It finds that 80% of syphilis cases are among African Americans, with the majority of cases being young people ages 15-34. Despite efforts to increase syphilis screening and testing, as well as community outreach campaigns, the county continues to see congenital syphilis cases. Moving forward, the health department aims to further coordinate with healthcare providers, evaluate the root causes of congenital cases, and continue community education efforts with the goals of reducing overall syphilis rates and achieving zero congenital syphilis cases by 2014.
3. P&S Syphilis Rates in the
United States by County in 2011
Baltimore
#4 (37.5)
San
Francisco
#2 (48.2)
Washington
D.C. #5 (27.4)
Fulton County,
GA #3 (39.3)
Caddo County, LA
#1 (59.2)
11. Syphilis Demographics: Age
Age Group
Sum (#)
%
<1
1-14
19
4
1.9%
0.4%
15-24
403
39.6%
25-34
313
30.7%
35-44
147
14.4%
45-54
97
9.5%
55-64
32
3.1%
>65
3
0.3%
12. Syphilis Demographics:
Behavioral Risk Factors
Target Prevention Efforts using these Risk Factors:
• Men having sex with men (MSM)
• Injection Drug Use (IDU) or sex with IDU
• Having sex with someone of the opposite
gender who is HIV+ or at risk of being HIV+
• Women having sex with MSM
• Women having sex in exchange for
money/drugs
• IDU or having sex with IDU
19. Congenital Syphilis Recent Trends
2011-2013
Cuyahoga
County is #3
with 3
cases
Franklin
County is #2
with 11
cases
20. Congenital Syphilis Recent Trends
2011-2013
Ohio Total: 42
Franklin
County is #2
with 11
cases
Cuyahoga
County is #3
with 3
cases
21. Congenital Syphilis
There is a 75-95% vertical transmission rate between
infected mother and fetus
Pregnant women with
untreated syphilis suffer a
40% fetal death rate
22. Congenital Syphilis – Prenatal Stats
• There were 22 cases of congenital syphilis reported in
Hamilton County from 2010-2012. Of these cases:
– 5 mothers (22.7%) were under the age of 19.
– 12 mothers (54.5%) received prenatal care from
hospital clinics, 4 mothers ( 18.2%) received prenatal
care from private physicians, and 1 mother (4.5%)
received prenatal care from an FQHC.
– 21 mothers (95.5%) had less than the 3
recommended RPR screenings during prenatal care.
– 18 mothers (81.8%) had less than 8 prenatal visits.
23. Congenital Syphilis
• Congenital syphilis serves as a key indicator of
community health, as it is an easily preventable
disease when proper healthcare is present.
• The Healthy People 2020 goal for congenital syphilis
is 9.1 per 100,000 live births; much lower than the
rate for Hamilton County in 2012 (54.6 per 100,000
live births).
• To meet the HP2020 goal, Hamilton County can
have 1 case of congenital syphilis.
• There have been 5 cases of congenital syphilis
reported within Hamilton County so far in 2013 (JanAug 2013).
25. Reporting Process
• Syphilis is a Class B1 disease in the Ohio
Infectious Disease Control Manual.
• Cases are to be reported to the local public
health department by the close of the next
business day after the case or suspected case
presents and/or there is a positive laboratory
result.
• These cases are usually submitted via fax or
by electronic lab reporting (ELR).
• Cases are prioritized.
26. Patient and Partner Follow-up
• HCPH staff offer partner services
• Persons infected with syphilis are interviewed
to:
– Elicit information about partners
– Notify the partners of possible exposure
– Ensure partners receive appropriate services
– Examination, treatment and referrals
– Provide prevention and risk reduction counseling
29. Hamilton County Syphilis Elimination
Healthcare Coalition Members
•
•
•
•
•
•
•
Cincinnati Children’s Hospital Medical Center
TriHealth
The Christ Hospital
Mercy Health
University of Cincinnati Medical Center
Public Health Depts—HCPH, CHD, N.KY Health
FQHC’s-Crossroads, WinMED, LHHC, NHC
30. HCPH Syphilis Elimination Strategy
• Enhanced Surveillance
• Health Care Mobilization-Targeted Screening
and Treatment @EDs and clinics
• HCPH Case and Partner Follow-up
• Community Outreach/Education
• Monitoring and Evaluation---Communication
31. Syphilis Testing: 2011 vs. 2012
Number of Screening Tests
Syphilis Testing by Hospital System, Hamilton
County, 2011-2012
Hospital System
2011
2012
35. Syphilis HotSpots: Healthy Moms & Babes
• HCPH contracted Healthy Moms and Babes
for syphilis testing in 10 Cincinnati
neighborhoods.
• In 2012, 141 tests were completed resulting in
the identification of 8 positive tests; 5.7 %
positivity.
• Health educators delivered
risk reduction messages
to 350 people
within the targeted neighborhoods.
36. Radio1
• HCPH supported testing program with
intensive radio and online campaign. The
campaign ran from October – December,
2012.
• Online survey, gauging knowledge of STIs
along with questions on STI testing.
• The campaign used well-known DJ for radio
spots. Theme: “Get real. Get tested. I did.”
38. Outreach in Schools
“Why are you telling us about this now...it’s too
late? We are seniors and getting ready to graduate.
You should have told us about this 4 years ago,
then we would have probably made different
decisions..” – several students in a local high school
“I’m addicted to sex and have had over 50 partners.
I only perform oral sex now because my mother
told me about getting HIV and she works at the
health clinic” – 15-year-old Colerain Twp female
39. Outreach in Faith-Based Organizations
“We have too many young girls who are
pregnant by the young boys sitting in our pews.
The message of waiting until marriage is not
working. We need another message.” – Head
Deacon in local church
“I don’t understand anything you are talking
about but I don’t want to get any diseases. I am
going to be smart and learn more about it.
Where can I get more information?” – 12-year-old
girl
40. Accomplishments and Progress
• 10% increase in syphilis screening and testing
from 2011 - 2012
• Healthcare awareness increased
• Community awareness and engagement
increased
• Accessible treatment sites
41. Moving Forward
• Further the education, communication and
care coordination among healthcare providers
• Develop a medical committee to determine
root cause of congenital cases
• Continue the community and school
education and engagement
• Evaluate and report results
42. Conclusions
• The syphilis epidemic continues
• Still seeing congenital cases
• More work to do by all of us
Healthcare providers -- please continue to:
– Treat syphilis cases presumptively upon clinical
manifestation
– Test for syphilis if person shows any STI symptoms
43. Our Goals
• To reduce the rate of syphilis to pre-epidemic
levels in Hamilton County by 2016
• Zero cases of congenital syphilis in 2014
Syphilis is 100% Preventable and
100% Treatable – It’s Up To Us!
44. Thank You!
Visit us online at www.HCPH.org
Find us on Social Media @HamCoHealth
Editor's Notes
Assist HCPH using a Five-Prong ApproachMultiple/Accessible Test &Treatment Referral Sites for Partners
Organizing people around the cause first takes research and understanding where people congregate. Locating people takes a multi-prong approach.Where do they live, go to school, church, play or recreate, work or volunteer. As I work to connect with people I ask them where should this message be shared. They almost always have someone else to connect with or talk to.
These comments are representative of what we’re hearing when visiting with high school students in the area.
This is typical of what I am hearing in the field.
Here is a quote that was in my Summit file from Obstetrics & Gynecology, 2012 Oct; 120(4): 882-8, Patel et al: “CONCLUSION: Providers missed well-defined opportunities to prevent congenital syphilis for the majority of cases. Combined efforts to prevent future cases include provider education and better integration of care between obstetricians and pediatricians.”