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Syphilis Outbreak in Southwestern Idaho — 2002 – 2003. Jared Bartschi, MHE STD/HIV Epidemiologist Idaho Dept. of Health and Welfare. Introduction. U.S. P&S syphilis rates show an increase after a decade of decline U.S. syphilis rates increasing among men

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syphilis outbreak in southwestern idaho 2002 2003

Syphilis Outbreak in Southwestern Idaho —2002 – 2003

Jared Bartschi, MHE

STD/HIV Epidemiologist

Idaho Dept. of Health and Welfare

introduction
Introduction
  • U.S. P&S syphilis rates show an increase after a decade of decline
  • U.S. syphilis rates increasing among men
  • Recently reported outbreaks describe syphilis among MSMs
  • Idaho experiencing a syphilis outbreak
    • 22 in 2000-2001
    • 64 in 2002-2003
objectives
Objectives
  • Determine the extent of the outbreak
  • Describe characteristics of the affected population
  • Follow up with patients and partners
  • Discuss difficulties with outbreak investigation and get suggestions from peers
case finding
Case-finding
  • Case-finding
    • Passive: laboratory and physician reporting
    • Active: contact tracing and testing
  • Laboratory testing
    • Nontreponemal (VDRL or RPR)
    • Treponemal (FTA-ABS or MHA-TP)
    • Dark-field microscopy NOT available
  • Interviews using CDC STD forms
case definitions
Case Definitions
  • Standard CSTE/CDC
  • Early syphilis
    • Primary syphilis (chancres)
    • Secondary syphilis (mucocutaneous lesions)
    • Early latent syphilis
      • Latent syphilis (no symptoms or signs)
      • Evidence of acquiring infection within previous12 months
patient characteristics number of partners
Patient Characteristics — Number of Partners
  • Reported number of opposite sex partners
  • Reported number same sex partners = 0
public health response
Public Health Response
  • Raising awareness
    • Health Alerts to area physicians
    • Press releases
    • Informational handouts / posters
    • Radio announcements
  • Follow-up infants from positive mothers
  • Visit by CDC Project Officer
limitations individual
Limitations — Individual
  • Withholding of partner information
  • Language barriers
  • Illiteracy in any language
limitations investigation
Limitations — Investigation
  • Lack of timely contact follow-up
  • Safety concerns
  • Travel time (large jurisdictions)
  • Incarcerated patients and partners
  • Out-of-jurisdiction and out-of-country partners
recommendations
Recommendations
  • Enhance syphilis screening during prenatal care for young Hispanics in SW ID
  • Syphilis screening for inmates upon intake at correctional facilities
  • Improve outreach to Hispanics in SW ID
  • Expand screening to social networks
future needs
Future Needs
  • Spanish language services
  • Educational materials for illiterate persons
  • Interview training for syphilis investigation
  • Permanent bridge to Hispanic community
  • Change in cultural norms
acknowledgments
Acknowledgments

Southwest District Health Department

Pat Harris, Epidemiology Supervisor

Craig Christiansen, Epidemiologist

Jennifer Tripp, Epidemiologist

Central District Health Department

Gladys Goodman, Epidemiologist

IDHW Office of Epidemiology and Food Protection

Christine Hahn, State Epidemiologist

Kris Carter, CDC EIS Officer

Centers for Disease Control and Prevention

Gail Gould, Public Health Advisor

Mary Hayes, STD Project Advisor