Update on Congenital Syphilis Elimination efforts, Chicago, IL - - PowerPoint PPT Presentation

Irina Tabidze, MD, MPH HIV/STI Bureau

Update on Congenital Syphilis Elimination efforts, Chicago, IL

• 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

Syphilis in Pregnancy

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

1 Los Angeles County, CA Los Angeles County, CA Los Angeles County, CA

59,116 cases 581.3/100,000 population 22,376 cases 220.0/100,000 population 1,814 cases 17.8/100,000 population

2 Cook County, IL Cook County, IL Cook County, IL 41,056 cases 783.8/100,000 population 13,608 cases 259.8/100,000 population 1,018 cases 19.4/100,000 population 3 Harris County, TX Harris County, TX New York County, NY

27,847 cases 613.6/100,000 population 8,496 cases 187.2/100,000 population 719 cases 43.7/100,000 population

State of IL Rate 72,201 cases

561.4/100,000 population

21,199 cases

164.8/100,000 population

1,260 cases

9.8/100,000 population

U.S. Rate 1,598,354 cases 497.3/100,000 population 468,514 cases 145.8/100,000 population 27,814 cases 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

10 20 30 40 50 60 70

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate/per 100,000 population Year

Total Males Female

CDPH, 2017 STI Surveillance report-unpublished

25 50 75 100 125 150 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

P&S syphilis cases in women CS cases

Year Number of cases

Target: ensure <12 congenital syphilis cases are diagnosed annually

78% of CS cases averted

CDPH, 2017 STI Surveillance report-unpublished data

P&S Syphilis Cases among Women & Congenital Syphilis Cases, Chicago, 2000-2016

Congenital Syphilis Cases by Race/Ethnicity, Chicago, 2008-2016

5 10 15 20 25 30 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total # of Cases Black, NH White, NH Hispanic Asian/PI Other/Unk Number of Cases Year

CDPH, 2017 STI Surveillance report-unpublished data

Average Annual Congenital Syphilis Rates by Community Rates, Chicago, 2011-2015

Mother received adequate treatment for syphilis that began ≥30 days prior to delivery?

Mother tested for syphilis ≥30 days prior to delivery?

Prenatal care, testing, and treatment status of mothers of reported Congenital Syphilis Cases (n=36), Chicago, 2015-2016

Reported Congenital syphilis Cases (n=36)

Yes

(n=22)

No

(n=14)

Yes (n=19) No (n=14) Yes (n=7) No (n=12) No (n=3) No (n=14)

Mother received any prenatal care≥30 days prior to delivery?

No (n=3)

39% 61%

Yes (n=0)

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 4th 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

• Chicago Department of Public Health
• Illinois Department of Public Health
• Centers for Disease Control and Prevention

Acknowledgments

Thank you Questions?