There is a Syphilis Epidemic in Cincinnati

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Hamilton County ranked #6 in the nation for cases of P&S syphilis (data source=CDC 2011) and #1 in the state of Ohio. In March 2012 a Syphilis Epidemic was declared in Hamilton County, Ohio. This presentation shows valuable data about this epidemic and how Hamilton County Public Health is fighting it.

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  • 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.”
  • There is a Syphilis Epidemic in Cincinnati

    1. 1. Hamilton County Syphilis Epidemic by Tim Ingram, Health Commissioner Picture
    2. 2. P&S Syphilis Rates in the United States by County in 2011
    3. 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)
    4. 4. All Types of Syphilis- Recent Trends
    5. 5. Epidemic Declaration
    6. 6. Faces of Syphilis in Hamilton County
    7. 7. Syphilis Demographics: Race 80% AfricanAmerican 15% Caucasian 5% Other
    8. 8. Syphilis Demographics: Race 80% AfricanAmerican 15% Caucasian 5% Other
    9. 9. Syphilis Demographics: Race 80% AfricanAmerican 15% Caucasian 5% Other
    10. 10. Syphilis Demographics: Gender Men 51% Women 49%
    11. 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. 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
    13. 13. Syphilis Demographics: Risk Factors 37% Over 1/3rd of all males with syphilis are MSM
    14. 14. Syphilis Demographics: Risk Factors 56% Over 1/2 of all females with syphilis are HRHF
    15. 15. Congenital Syphilis
    16. 16. Congenital Syphilis 160,419 women were of child-bearing age (15-44 Years) 44% of all syphilis cases were among women of child-bearing age
    17. 17. Congenital Syphilis Recent Trends 2011-2013
    18. 18. Congenital Syphilis Recent Trends 2011-2013 Franklin County is #2 with 11 cases
    19. 19. Congenital Syphilis Recent Trends 2011-2013 Cuyahoga County is #3 with 3 cases Franklin County is #2 with 11 cases
    20. 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. 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. 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. 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).
    24. 24. The Public Health Process – Hamilton County Picture
    25. 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. 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
    27. 27. Syphilis Case Investigation Reports 2013 95% of Syphilis cases TREATED
    28. 28. Other Partners • Healthcare • Community
    29. 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. 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. 31. Syphilis Testing: 2011 vs. 2012 Number of Screening Tests Syphilis Testing by Hospital System, Hamilton County, 2011-2012 Hospital System 2011 2012
    32. 32. Syphilis Testing: Q2 2012 vs. Q2 2013 Facility Tests Q2 2012 Q2 2012 (%P) Q2 2013 Q2 2013 (%P) 1 RPR 845 0.47 1668 2.04 2 RPR 2039 1.37 1965 1.73 3 RPR 2505 7.94 3110 7.72 4 RPR(2012)/CIA(2013 ) 1734 0.87 1460 2.05 5 RPR/EIA 6392* 0.86* 6 RPR 1399 1.64 1710 1.70 7 RPR 1953* 5.27* 2118 4.67
    33. 33. Provider Awareness
    34. 34. Community Outreach, Education, Awareness People Work/ Volunteer Live Organizing Centers/ Play School Church
    35. 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. 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.”
    37. 37. WCPO Series
    38. 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. 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. 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. 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. 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. 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. 44. Thank You! Visit us online at www.HCPH.org Find us on Social Media @HamCoHealth

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