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TRANSCRIPT
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
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
0
100
200
300
400
500
600
700
800
Ra
te p
er
10
0,0
00
Po
pu
latio
n
Num
ber
of
Cases
Cases Rate *2016 data is preliminary
Kern Primary and Secondary Syphilis
Cases
0.0
5.0
10.0
15.0
20.0
25.0
30.0
0
50
100
150
200
250
Ra
te p
er
10
0,0
00
Po
pu
latio
n
Num
ber
of
Cases
Cases Rate *2016 data is preliminary
Female Primary and Secondary
Syphilis by Jurisdiction
0
2
4
6
8
10
12
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
per
10
0,0
00 P
op
ula
tio
n
Kern California
2016 Kern Primary and Secondary
Syphilis by Sex and Age Group
0
10
20
30
40
50
60
70
80
15-19 years 20-24 years 25-29 years 30-34 years 35-44 years 45+ years
Rate
pe
r 1
00
,00
0 P
op
ula
tion
Males Females
Male incidence rate
Female incidence rate
*2016 data is preliminary
2016 Kern Primary and Secondary
Syphilis Race/Ethnicity and Sex
0
10
20
30
40
50
60
70
80
Hispanic NH White NH Black Other
Rate
pe
r 1
00
,00
0 P
op
ula
tion
Males Females *2016 data is preliminary
Male incidence rate
Female incidence rate
Kern County Congenital Syphilis
0.0
50.0
100.0
150.0
200.0
250.0
0
5
10
15
20
25
30
Ra
te p
er
10
0,0
00
Po
pu
latio
n
Nu
mb
er
of C
ase
s
Cases Rate *2016 data is preliminary
Congenital Syphilis Incidence by
Jurisdiction
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
200.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Rate
per
1,0
00
Liv
e B
irth
s
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?