Hamilton County Syphilis Epidemic

by

Tim Ingram, Health Commissioner

Picture

P&S Syphilis Rates in the

United States by County in 2011

P&S Syphilis Rates in the

United States by County in 2011

Baltimore

#4 (37.5)Washington

D.C. #5 (27.4)

Fulton County, GA

#3 (39.3)

Caddo County, LA

#1 (59.2)

San

Francisco

#2 (48.2)

All Types of Syphilis- Recent Trends

Epidemic Declaration

Faces of Syphilis in Hamilton County

80%

African-

American

15%

Caucasian

5%

Other

Syphilis Demographics: Race

80%

African-

American

15%

Caucasian

5%

Other

Syphilis Demographics: Race

80%

African-

American

15%

Caucasian

5%

Other

Syphilis Demographics: Race

Syphilis Demographics: Gender

Men 51% Women 49%

Syphilis Demographics: Age

Age Group Sum (#) %

<1 19 1.9%1-14 4 0.4%

25-34 313 30.7%

35-44 147 14.4%

45-54 97 9.5%

55-64 32 3.1%

>65 3 0.3%

15-24 403 39.6%

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

Syphilis Demographics: Risk Factors

Over

1/3rd of

all males with

syphilis are

MSM

37%

Syphilis Demographics: Risk Factors

Over 1/2 of

all females

with syphilis

are HRHF

56%

Congenital Syphilis

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

Congenital Syphilis Recent Trends

2011-2013

Congenital Syphilis Recent Trends

2011-2013

Franklin

County is #2

with 11

cases

Congenital Syphilis Recent Trends

2011-2013

Franklin

County is #2

with 11

cases

Cuyahoga

County is #3

with 3

cases

Congenital Syphilis Recent Trends

2011-2013

Franklin

County is #2

with 11

cases

Cuyahoga

County is #3

with 3

cases

Ohio Total: 42

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

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.

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 (Jan-Aug 2013).

The Public Health Process – Hamilton County

Picture

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.

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

Syphilis Case Investigation Reports

2013

95% of

Syphilis

cases

TREATED

Other Partners

• Healthcare

• Community

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

• 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

HCPH Syphilis Elimination Strategy

Syphilis Testing: 2011 vs. 2012

Syphilis Testing by Hospital System, Hamilton County, 2011-2012

2011 2012Hospital System

Num

ber o

f Scr

eeni

ng T

ests

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

Provider Awareness

Organizing

People

Live

School

Church

Centers/ Play

Work/ Volunteer

Community Outreach, Education, Awareness

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.

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.”

WCPO Series

“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

Outreach in Schools

“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

Outreach in Faith-Based Organizations

Accomplishments and Progress

• 10% increase in syphilis screening and testing from 2011 - 2012

• Healthcare awareness increased• Community awareness and engagement

increased• Accessible treatment sites

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

• 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

Conclusions

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!

Thank You!

Visit us online at www.HCPH.org

Find us on Social Media @HamCoHealth