Transcript Enhanced Syphilis Surveillance in Baltimore

Enhanced Syphilis Surveillance
in Baltimore
Scott Tulloch
Maryland State Department of
Health and Mental Hygiene
Comprehensive Evaluation of the
Syphilis Surveillance System
• Over period of 1999-2000, the SEP
performed evaluation of surveillance
system following CDC guidelines
• 18 recommendations generated
• Most have been implemented, others
are in process of implementation
Elements of Enhanced Syphilis
Surveillance in Baltimore
• Expanded data collection (especially
behavioral risks)
• Enhanced syphilis interview
• Jail Stat Lab project
• Cross-jurisdictional data sharing
• Expanded community screening
Behavioral Risk
(Local Use) Variables
• Collected on all syphilis cases as part of
Original Patient Interview
• Immediately indicates membership in
suspected high prevalence networks
• People who in engage in these
behaviors are considered integral to
spread of syphilis
Local Use Variables
Local Use Variables from Interviews
Apr. 2001 – Jan. 2002 (n=120)
Risk
Male
(n=67)
Female
(n=53)
MSM
7 (10%)
-
Exchange Drugs
1 (2%)
0
Exchange Money
22 (33%)
7 (13%)
Exchange Drugs
and Money
1 (2%)
4 (8%)
Used Heroin/Crack
12 (18%)
18 (34%)
Congenital Syphilis
Supplemental Data Collection
• CDC 126 form can be limited for
diagnosing CS risks
• Designed supplemental data collection
form to be used with CS investigations
• Presently collect detailed data on:
– Prenatal care during each trimester
– If no prenatal care, reason(s) why
– Drug screen information
– Risk history of mother
Modified Interview:
The Syphilis Assessment
• Since December 2000, syphilis cases
have been asked to identify locations
where they met their sex partner(s)
• Cases also report on risk behaviors
occurring at these meeting places
Assessment
Form
-Focuses on where
cases met their
sex partners
-Scanned into a
database
-Places and risks
are mapped using
GIS software
Sex Partner Meeting Places
(n=55)
Street/Corner
53%
Private residence
13%
Bar/club
9%
Strip club
6%
Workplace/office
4%
Park
4%
Other/Unknown
13%
Stat Lab Project
• Jail-based rapid disease intervention
initiative
• Prevalence monitoring of high-risk
population
• Partnering with local SE activities
2001-Q4
2001-Q3
2001-Q2
2001-Q1
2000-Q4
2000-Q3
Female
2000-Q2
2000-Q1
1999-Q4
1999-Q3
1999-Q2
1999-Q1
1998-Q4
1998-Q3
1998-Q2
1998-Q1
Syphilis Reactor Prevalence (in%)
At Baltimore City Jail By Sex and Quarter,
1998-2001
Male
16
14
12
10
8
6
4
2
0
Percentage of Baltimore City P&S Syphilis
Identified By Jail-Based Screening By Year
(1999-2001)
300
250
200
Statlab
Baltimore City
150
100
50
0
1999
2000
2001
Associated Risk Factors for P&S Syphilis
Cases Identified by Jail-Based Screening
(2001)
Risk
Sex for Drugs/Money
Number of Cases with
Identified Risk Factor
(n=30)
18 (60%)
IDU
8 (27%)
Cocaine/Crack Use
12 (40%)
MSM
0
Cross-Jurisdictional Data Sharing
• Assessment forms used by Baltimore
are also used in surrounding counties,
including jails.
• Jail screening data (under jurisdiction of
MD state), can now be shared for more
complete syphilis histories
Enhanced Community Screening
• “Piggyback” syphilis screening at sites
where blood is being drawn for HIV test
• Create leadership through funding key
CBO partners
• Partner with community clinics
• Rapid Response Team outreach
screening
Conclusion
• Creating an effective “tool”
– Multi-pronged approached
– Representative
• Data supported interventions
• Community Involvement
– Community
– Community
– Community