Update on Congenital Syphilis Elimination efforts, Chicago, IL Irina Tabidze, MD, MPH HIV/STI Bureau
Syphilis in Pregnancy • Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum . • Perinatal transmission of Treponema pallidum can occur at any time during gestation and at any stage of disease • Primary & secondary syphilis during pregnancy is usually devastating for the fetus • About half (50%) of untreated latent infections result in adverse pregnancy outcomes • Adverse outcomes include: • Fetal loss and stillbirth: 21% • Neonatal death: 9.3% • Prematurity or low birth weight: 5.8% • Congenital infection and anomalies: 15% Gomez et al. 2013
Chlamydia, Gonorrhea, and Primary and Secondary (P&S) Syphilis - Counties and Independent Cities Cases and Rates Ranked by Number of Reported Cases: United States, 2016 Rank Chlamydia Gonorrhea P&S Syphilis Los Angeles County, CA Los Angeles County, CA Los Angeles County, CA 1 59,116 cases 22,376 cases 1,814 cases 581.3/100,000 population 220.0/100,000 population 17.8/100,000 population Cook County, IL Cook County, IL Cook County, IL 2 41,056 cases 13,608 cases 1,018 cases 783.8/100,000 population 259.8/100,000 population 19.4/100,000 population Harris County, TX Harris County, TX New York County, NY 3 27,847 cases 8,496 cases 719 cases 613.6/100,000 population 187.2/100,000 population 43.7/100,000 population State of IL 72,201 cases 21,199 cases 1,260 cases Rate 561.4/100,000 population 164.8/100,000 population 9.8/100,000 population 1,598,354 cases 468,514 cases 27,814 cases U.S. Rate 497.3/100,000 population 145.8/100,000 population 8.7/100,000 population Centers for Disease Control and Prevention, Sexually Transmitted Disease Surveillance Report 2016
P&S Syphilis, Rates by Gender, Chicago, 1998-2016 70 Males 60 Rate/per 100,000 population 50 40 Total 30 20 10 Female 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year CDPH, 2017 STI Surveillance report-unpublished
P&S Syphilis Cases among Women & Congenital Syphilis Cases, Chicago, 2000-2016 150 P&S syphilis cases in women 125 CS cases 100 Number of cases 78% of CS cases averted 75 50 25 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year Target: ensure <12 congenital syphilis cases are diagnosed annually CDPH, 2017 STI Surveillance report-unpublished data
Congenital Syphilis Cases by Race/Ethnicity, Chicago, 2008-2016 30 25 Number of Cases 20 15 10 5 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 Year Total # of Cases Black, NH White, NH Hispanic Asian/PI Other/Unk CDPH, 2017 STI Surveillance report-unpublished data
Average Annual Congenital Syphilis Rates by Community Rates, Chicago, 2011-2015
Prenatal care, testing, and treatment status of mothers of reported Congenital Syphilis Cases (n=36), Chicago, 2015-2016 Reported Congenital syphilis Cases (n=36) Mother received any prenatal care≥30 days prior to delivery? 61% 39% Yes No (n=22) (n=14) Mother tested for syphilis ≥30 days prior to delivery? Yes No No (n=19) (n=14) (n=3) Mother received adequate treatment for syphilis that began ≥30 days prior to delivery? Yes No Yes No No (n=7) (n=12) (n=0) (n=3) (n=14)
Speaking of Treatment: Bicillin L-A Shortage • In pregnancy, benzathine penicillin is the only recommended therapy. No alternatives. • Bicillin L-A shortage appears to be ongoing; full recovery expected in 4 th quarter 2017 • Penicillin G procaine is one of the oddslot recommended treatments for congenital syphilis • Note: There is also a Penicillin G Procaine shortage
What we are doing? Enhanced Congenital syphilis surveillance activities and Data • Collection Under MCH Service Code 77 lll. Adm. Code 630, all licensed Illinois hospitals arerequired to report infants meeting APORS criteria within 7 days (syphilis is reportable condition)* In collaboration with state of IL, developed Congenital Syphilis • Morbidity and Mortality Case Review Board Conducted exploratory interviews of females diagnosed with • syphilis In March, 2016, launched a Congenital Syphilis media campaign, • including Healthychicagobabies.org website CDPH Partner Services team has extensive grassroots expertise • and understanding of community, client and health network dynamics and are key collaborators in the prevention of CS Source: http://www.idph.state.il.us/about/epi/apors.htm
Congenital Syphilis Media Campaign
Current Partnership • Program is utilizing coordinated strategy through a collaborative partnership with CDPH Bureau of Maternal, Infant, Child, and Adolescent Health (MICAH), IDPH, Cook County Department of Public Health, Pediatric AIDS Chicago Prevention initiative and St. Louis STD/HIV prevention training center
Next Steps CDPH Bureau STI/HIV is one of the project areas that received award from the CDC to strengthen capacity to address and respond to CS elimination activities. Specifically: Improve CS case data collection, including maternal and fetal epidemiologic and clinical • risk factor data Improve collection of pregnancy status for all cases of syphilis among women of • reproductive age; Case management/linkage to the prenatal care or family planning (FP) services Strengthen CS morbidity and mortality case review boards to help identify causes of CS • and develop interventions to address causes Improve methods to match vital statistics birth and mortality data with syphilis • surveillance data to review syphilis testing practices among stillbirths, identify missed cases of syphilis-related stillbirth, and strengthen CS stillbirth case report data Strengthen partnerships with health care providers, CBOs, state and local Title V • maternal and child health programs, Medicaid programs, and health care organizations We are planning to launch new media campaign in 2018 •
Acknowledgments Chicago Department of Public Health • Illinois Department of Public Health • Centers for Disease Control and Prevention •
Thank you Questions?
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