there is a syphilis epidemic in cincinnati
DESCRIPTION
Hamilton County ranked #6 in the nation for cases of P&S syphilis (data source=CDC 2011) and #1 in the state of Ohio. In March 2012 a Syphilis Epidemic was declared in Hamilton County, Ohio. This presentation shows valuable data about this epidemic and how Hamilton County Public Health is fighting it.TRANSCRIPT
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Hamilton County Syphilis Epidemic
by
Tim Ingram, Health Commissioner
Picture
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P&S Syphilis Rates in the
United States by County in 2011
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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)
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All Types of Syphilis- Recent Trends
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Epidemic Declaration
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Faces of Syphilis in Hamilton County
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80%
African-
American
15%
Caucasian
5%
Other
Syphilis Demographics: Race
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80%
African-
American
15%
Caucasian
5%
Other
Syphilis Demographics: Race
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80%
African-
American
15%
Caucasian
5%
Other
Syphilis Demographics: Race
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Syphilis Demographics: Gender
Men 51% Women 49%
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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%
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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
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Syphilis Demographics: Risk Factors
Over
1/3rd of
all males with
syphilis are
MSM
37%
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Syphilis Demographics: Risk Factors
Over 1/2 of
all females
with syphilis
are HRHF
56%
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Congenital Syphilis
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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
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Congenital Syphilis Recent Trends
2011-2013
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Congenital Syphilis Recent Trends
2011-2013
Franklin
County is #2
with 11
cases
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Congenital Syphilis Recent Trends
2011-2013
Franklin
County is #2
with 11
cases
Cuyahoga
County is #3
with 3
cases
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Congenital Syphilis Recent Trends
2011-2013
Franklin
County is #2
with 11
cases
Cuyahoga
County is #3
with 3
cases
Ohio Total: 42
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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
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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.
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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).
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The Public Health Process – Hamilton County
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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.
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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
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Syphilis Case Investigation Reports
2013
95% of
Syphilis
cases
TREATED
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Other Partners
• Healthcare
• Community
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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
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• 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
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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
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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
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Provider Awareness
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Organizing
People
Live
School
Church
Centers/ Play
Work/ Volunteer
Community Outreach, Education, Awareness
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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.
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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.”
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WCPO Series
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“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
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“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
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Accomplishments and Progress
• 10% increase in syphilis screening and testing from 2011 - 2012
• Healthcare awareness increased• Community awareness and engagement
increased• Accessible treatment sites
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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
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• 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
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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!
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Thank You!
Visit us online at www.HCPH.org
Find us on Social Media @HamCoHealth