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1
Congenital Syphilis: Epidemiology, Impact and Interventions
Ed Weckerly, Epidemiologist
Sydney Minnerly, Syphilis Elimination Coordinator
2
What is Congenital Syphilis?
A pregnant woman infected with syphilis may transmit the infection to the fetus
If untreated, congenital syphilis may lead to:StillbirthNeonatal deathDeafnessNeurologic impairmentBone deformities
3
Congenital Syphilis Surveillance
Case DefinitionsNo CasePresumptive CaseConfirmed CaseStillbirth
Fill out the Congenital Report Form
Enter into STD*MIS
4
Primary and Secondary Syphilis Cases:Texas, 1971-2009
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09
Year
Cas
es
5
National Comparison (P&S Syphilis)
In 20081,405 cases (5.9 per 100,000 -
10th highest)10% of the 13,500 cases in the
U.S.U.S. rate was 4.5 (CDC 2008 Surveillance Report:
http://www.cdc.gov/std/stats08/tables/24.htm)
In 20091,644 cases in Texas (6.6 per
100,000)
6
P&S Syphilis Case Rates by County:Texas, 2009
Rates 0.0 Cases/100,000 0.1 to 1.9 Cases/100,000 2.0 to 3.9 Cases/100,000 4.0 to 9.9 Cases/100,000 10 or More Cases/100,000
7
P&S Syphilis Case Rates by Race/Ethnicity: Texas, 1998-2009
0
5
10
15
20
25
30
35
40
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es p
er 1
00,0
00
Black Hispanic White
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P&S Syphilis Case Rates by Year of Reportand Sex: Texas, 1998-2009
0
1
2
3
4
5
6
7
8
9
10
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es p
er 1
00,0
00
Female
Male
9
P&S Syphilis Cases by Sex and MSM:Texas, 2002-2009
37%36%41%45%52%57%40%
21%
22% 20%30% 33% 32%
33%
36%46%
22% 28%
25%26%
32%
30%
25%33%
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es
MSM P&S Other Male P&S Female P&S
10
Congenital Syphilis Cases:Texas, 1991-2009
0
50
100
150
200
250
300
350
400
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09
Year
Cas
es
11
Congenital Syphilis Case Rates* by Year of Report: Texas, 2000-2009
16.3
21.020.4
17.0
31.1
31.1
23.8
19.5
19.7
19.1
0
5
10
15
20
25
30
35
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es p
er 1
00,0
00
*CS cases per 100,000 live births. 2007-2008 live birth totals were unavailable so the 2006 total was used for the calculation.
12
National Comparisons (Congenital Syphilis)
In 2008124 cases (31 per 100,000 - 2nd
highest)29% of the 431 cases in the U.S.U.S. rate was 10 (CDC 2008 Surveillance Report
http://www.cdc.gov/std/stats08/tables/39.htm)
In 2009124 cases in Texas (31 per 100,000)32% of the 385 cases in the U.S.
(provisional)
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Congenital Syphilis Case Rates* by County: Texas, 2009
*CS cases per 100,000 live births. 2006 live birth numbers were used for the calculation as more recent data were unavailable.
Rates 0.0 Cases/100,000
1 to 49 Cases/100,000
50 to 99 Cases/100,000
100 or More Cases/100,000
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1 Dot per CS Case
Congenital Syphilis Cases by County:Texas, 2009
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P&S Syphilis Case Rates and Congenital Syphilis Cases by County: Texas, 2009
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Rates 0.0 Cases/100,000 0.1 to 1.9 Cases/100,000 2.0 to 3.9 Cases/100,000 4.0 to 9.9 Cases/100,000 10 or More Cases/100,000
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1 Dot per CS Case
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Congenital Syphilis Cases by Year and County: Texas, 2000-2009
0
20
40
60
80
100
120
140
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es
Harris Dallas TarrantBexar Jefferson Region 4/5Cameron/Hidalgo Other Counties
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What are the Chances?
The number of congenital syphilis cases in a given year has been closely tied to the number of P&S syphilis cases in women in the preceding year…
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Congenital Syphilis Cases and Female P&S Syphilis Case Rates by Year: Texas, 2000-2009
0
20
40
60
80
100
120
140
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Con
gen
ital
Cas
es
0
1
2
3
4
5
6
7
Fem
ale
P&
S C
ases
/100
,000
Congenital Cases Female P&S Rate
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Congenital Syphilis Cases per 100 FemaleP&S Syphilis Cases: Texas, 2000-2009
3539.3
34.3
40.1
27.5
40.135.8
40.6
47.1
41.3
0
10
20
30
40
50
60
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Rat
e*
* CS cases per 100 P&S cases among females in the preceding year
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Congenital Syphilis Case Rates* by Year ofReport and Race: Texas, 2000-2009
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
Cas
es p
er 1
00,0
00
White Black Hispanic
*CS cases per 100,000 live births. 2007-2008 live birth totals were unavailable so the 2006 total was used for the calculation.
21
Texas Congenital Syphilis Cases and General Population Births by Vital Status of Child
Alive11492%
Stillborn108%
Alive399,309
99%
Stillborn2,476<1%
2009 Cases 2006 General Population
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Texas Congenital Syphilis Cases and General Population Births by Race
Hispanic50
40%
Black64
52%
White7
6%
Other3
2%
White138,443
35%
Black45,87711%
Other114%
Hispanic198,162
50%
2009 Cases 2006 General Population
23
Texas Congenital Syphilis Cases and General Population Births by Maternal Prenatal Care
Yes68
55%
Unk119%
No45
36%
Yes382,170
96%
No17,139
4%
2009 Cases 2006 General Population
24
Texas Congenital Syphilis Cases and General Population Births by Number of Prenatal Visits
Unk43
35%
None45
36%
10+8
6%
5-98
6%1-420
16%
Unk1,7240%
None16,123
4%
10+247,873
64%
5-9100,856
26%
1-418,961
5%
2009 Cases 2005 General Population
25
Syphilis Testing and Treatment During Pregnancy for Texas Congenital Cases
Unknown13
10%
Pos <30 days before delivery
7561%
Pos and >30 days before
delivery, inadequate or no
treatment108%
Pos and treated >30 days before
delivery but inappropriate
response26
21%
2009 Cases
26
What is being done in Texas?
Working on a comprehensive statewide congenital plan Our goal is to reduce the number of
congenital cases in Texas by 25% within 5 years
Target activities involve the following areas:
Surveillance Programmatic Providers/Clinical Settings/Services Promotion and Awareness
27
Surveillance Activities
Map primary, secondary and congenital cases by county
Review congenital cases in real time
Increase accessibility to testing and treatment history
Improve reporting accuracy by programs
28
Programmatic Activities
Target high-risk populations through prevention programs
Revise Program Operating Procedures for working congenital cases
Reach out to other programs which work with pregnant women
29
Providers/Clinical Services
Promote awareness to providers in high-morbidity areas
Present to Perinatal HIV Consortium Recommend 3rd trimester testing in high-
morbidity/high-risk populations Ensure all pregnant women who test positive
for any STD are also tested for syphilis Monitor treatment options used for women
who present as allergic to penicillin Evaluate desensitization policies of programs
30
Promotion and Awareness
Stomp Out Syphilis campaign Develop congenital syphilis brochure Develop and post congenital FAQ sheet Continue congenital meetings Develop training for contractors Ensure pregnant women are accessing
prenatal Posted one page summary of law
changes Add 3rd trimester testing module to
perinatal training for providers
31
Conclusion
Texas is at a turning point in addressing congenital syphilis cases
Continue to address racial and socio-economic disparities
Requires the collaboration of many entities
