CONGENITAL SYPHILIS

IN KERN COUNTY

Elaine Anthony, MSA-HCM, RN, PHN

MCAH Coordinator

Kern County Public Health Services Department

MCAH Action Education Day

May 18, 2017

Kern County Syphilis Cases

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Cases

Cases Rate *2016 data is preliminary

Kern Primary and Secondary Syphilis

Cases

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Cases Rate *2016 data is preliminary

Female Primary and Secondary

Syphilis by Jurisdiction

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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Kern California

2016 Kern Primary and Secondary

Syphilis by Sex and Age Group

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15-19 years 20-24 years 25-29 years 30-34 years 35-44 years 45+ years

Rate

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Males Females

Male incidence rate

Female incidence rate

*2016 data is preliminary

2016 Kern Primary and Secondary

Syphilis Race/Ethnicity and Sex

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Hispanic NH White NH Black Other

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Males Females *2016 data is preliminary

Male incidence rate

Female incidence rate

Kern County Congenital Syphilis

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Cases Rate *2016 data is preliminary

Congenital Syphilis Incidence by

Jurisdiction

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Rate

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Kern California U.S.

Kern Congenital Syphilis by Mother’s

Age Group, 2016

6, 22%

6, 21%

10, 36%

6, 21% 15-19 years

20-24 years

25-29 years

30-34 years

35-44 years

45+ years

Kern Congenital Syphilis by Mother’s

Diagnosis, 2016

2, 7%

5, 18%

16, 57%

4, 14%

1, 4% Primary

Secondary

Early Latent

Late Latent

Latent, UnknownDuration

Unknown Stage

Kern Congenital Syphilis by Timing

of Mother’s Diagnosis, 2016

13, 46%

14, 50%

1, 4%

More than 30 DaysBefore Delivery

Less than 30 DaysBefore Delivery

Unknown

Kern Congenital Syphilis by Trimester

of Prenatal Care, 2016

3, 11%

6, 21%

3, 11%

16, 57%

1st Trimester

2nd Trimester

3rd Trimester

Unknown Trimester

No Prenatal Care

Kern Congenital Syphilis by Treatment

Outcome, 2016

17, 61% 4, 14%

4, 14%

3, 11% No Prenatal Treatment

Incomplete Treatment

Tx Not 30 Days BeforeDelivery

Timely, Adequate Tx

18 Probable Congenital

Syphilis Cases in 2014

Identified:

No prenatal care

Inconsistent prenatal care

Failure to complete treatment

Late Latent cases were being closed

after 1st dose of Bicilin

Substance use

Kern Congenital Syphilis

Infant Outcomes, 2011-2016 6, 7%

2, 3%

75, 90%

Fetal Demise

Perinatal Death

Live Birth, Survived

Routine Syphilis Surveillance

Receive provider and laboratory reports

Reviewed by Public Health Nurse or

Medical Investigator

Verify adequate, appropriate treatment

Interview the patient

Partner notification

Enhanced Surveillance

Spreadsheet of syphilis cases

Biweekly case review

Ensure completion of 3 doses of Bicilin

Referral to MCAH Mommy and Me and Perinatal Outreach Program (POP) and/or Public Health Nursing

Assistance with transport to clinic

Determine birthing hospital and send notification prior to delivery

Case Management Advantages

Linkage to prenatal care

Education resources for mom

High risk infant follow up

Linkage to car seat for infant

Coordination with CPS

Successes

At least 60 infants born in 2015 and

2016 to syphilis(+) mothers NOT

infected with syphilis

Successes:

Coordinated Health Care

Infant

Treated in hospital

Referred for

additional services

Followed by

pediatrician

Mother

1st dose in hospital

Additional doses

outpatient

Referred for

additional services

Coordination with delivery hospital

regarding mother’s treatment history

Challenges

Substance use: difficult clients to reach and keep in care

Lack of transportation and childcare continue to be barriers to care

No prenatal care, late entry into prenatal care, and inconsistent prenatal care delay diagnosis and treatment

Opportunities

Increased collaboration with delivery hospitals

Increased awareness in the community

Strategies to address lack of prenatal care

Strategies to address substance use

Congenital Syphilis Public Awareness

Campaign

Questions?