Congenital syphilis occurs when a pregnant woman with syphilis passes the infection to her fetus. If untreated, it can cause stillbirth, neonatal death, deafness, neurological impairment, or bone deformities in the infant. The document discusses epidemiological data on congenital syphilis and syphilis cases in Texas from 1991-2009 which show high rates compared to national levels. It outlines Texas' plan to reduce congenital syphilis cases by 25% in 5 years through improved surveillance, targeting high-risk populations, promoting screening, and ensuring treatment.

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