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 InterviewsApr. 2001 – Jan. 2002 (n=120)

RiskMale

(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

Syphilis Reactor Prevalence (in%) At Baltimore City Jail By Sex and Quarter,

1998-2001

02468

10121416

1998

-Q1

1998

-Q2

1998

-Q3

1998

-Q4

1999

-Q1

1999

-Q2

1999

-Q3

1999

-Q4

2000

-Q1

2000

-Q2

2000

-Q3

2000

-Q4

2001

-Q1

2001

-Q2

2001

-Q3

2001

-Q4

Female Male

Percentage of Baltimore City P&S Syphilis Identified By Jail-Based Screening By Year

(1999-2001)

0

50

100

150

200

250

300

1999 2000 2001

Statlab

Baltimore City

Associated Risk Factors for P&S Syphilis Cases Identified by Jail-Based Screening

(2001)Risk Number of Cases with

Identified Risk Factor (n=30)

Sex for Drugs/Money 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