Enhanced Syphilis Surveillance in Baltimore

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Enhanced Syphilis Surveillance in Baltimore

• Scott Tulloch
• Maryland State Department of Health and Mental
  Hygiene

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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

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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

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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

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Local Use Variables
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Local Use Variables from InterviewsApr. 2001
Jan. 2002 (n120)
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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

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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

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Assessment Form -Focuses on where cases met their
sex partners -Scanned into a database -Places and
risks are mapped using GIS software
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Sex Partner Meeting Places (n55)
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Stat Lab Project

• Jail-based rapid disease intervention initiative
• Prevalence monitoring of high-risk population
• Partnering with local SE activities

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Syphilis Reactor Prevalence (in) At
Baltimore City Jail By Sex and Quarter, 1998-2001
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Percentage of Baltimore City PS Syphilis
Identified By Jail-Based Screening By Year
(1999-2001)
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Associated Risk Factors for PS Syphilis Cases
Identified by Jail-Based Screening (2001)
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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

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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

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Conclusion

• Creating an effective tool
• Multi-pronged approached
• Representative
• Data supported interventions
• Community Involvement
• Community
• Community
• Community