— New CDC Analysis shows 1 in 2 newborn syphilis cases in the United States occurs due to gaps in testing and treatment during prenatal care —
Washington, DC, June 4, 2020 - Today, the National Association of City and County Health Officials (NACCHO), representing the nation’s nearly 3,000 local governmental health departments, announced the launch of its new project, “Innovations in Congenital Syphilis Prevention,” to support local health departments in addressing the alarming rise of congenital syphilis cases. This launch coincides with the release of a new analysis from the Centers for Disease Prevention and Control (CDC) that finds that 1 in 2 newborn syphilis cases in the United States occurs due to gaps in testing and treatment during prenatal care.
“This new analysis highlights gaps in care that have helped fuel a resurgance of congenital syphilis,” said NACCHO CEO, Lori Tremmel Freeman, MBA. “However, it also shows us clear areas for intervention across public health and health care partners alike. Local health departments are taking the lead by implementing innovative programs and initiatives to move the needle on improving the health of pregnant people and their children. We know that when it comes to congential syphillis simple testing and treatment saves lives, but we must close the gaps in care to ensure that this is available to all who need it. NACCHO’s “Innovations in Congenital Syphilis Prevention,” aims to jumpstart this important work to improve outcomes in the funded communities, but also to develop evidence that can be adapted to communities across the country.”
Data show these congenital syphilis (CS) cases occur when pregnant people are diagnosed but not adequately treated for syphilis; when they are not tested early during prenatal care; or when they contract syphilis later in pregnancy after an initial negative test. Additionally, 1 in 4 cases are among women who did not receive timely prenatal care and testing. Missed opportunities differ by region, underscoring the need for tailored prevention. Despite the dramatic rise in congenital syphilis (up 261% from 2013-18) and related deaths (94 in 2018 alone), simple testing and treatment saves lives.
NACCHO, in partnership with CDC’s Division of STD Prevention (DSTDP), is supporting a diverse set of local health departments (LHDs) to galvanize local efforts to address rising rates of congenital syphilis and syphilis among pregnant individuals and individuals of child-bearing capacity. Funded jurisdictions will implement and evaluate their innovation or improvement, including addressing pregnancy testing, pregnancy intention ascertainment, STI testing and treatment, partner services, case management, and referral to care, over approximately 12 months.
While NACCHO and CDC encourage all healthcare providers to follow CDC’s testing and treatment recommendations, the resurgence of syphilis and congenital syphilis cannot be tackled in the exam room alone. It will require action from everyone: CDC, health departments, providers, community leaders, universities and industry, individuals, and the healthcare system at large.
The six funded jurisdictions were selected through a competitive process to collaborate on this project. They are:
- The New York City Bureau of STI
- The Maricopa County Department of Public Health
- Tulare County Health and Human Services Administration Public Health
- The Florida Department of Health, Miami-Dade
- Gwinnett, Newtown, and Rockdale County Health Departments
- The San Antonio Metropolitan Health District
The New York City Bureau of STI is piloting a Congenital Syphilis Prevention Investigator (CPI) Model, which will designate one CPI to investigate all syphilis investigations among persons who are or may become pregnant in their respective region.
The Maricopa County Department of Public Health is collaborating with CAN Community Health community partners to utilize mobile healthcare clinics to provide STI diagnosis and treatment to individuals at highest risk of a pregnancy with congenital syphilis—including those experiencing homelessness, engaging in drug use, or recently incarcerated.
Tulare County Health and Human Services Administration Public Health will provide communication and counseling, delivered by disease intervention specialists, through telehealth to monitor patients for syphilis and confirm their treatment. They also hope to use a telehealth referral process for syphilis patients to use with their partners.
The Florida Department of Health, Miami-Dade is expanding their smart screening algorithm for syphilis—which involves integrating syphilis screening into existing routine, “opt-out” HIV and hepatitis C screening initiatives in emergency departments—into a second hospital which had 50% of the county’s congenital syphilis cases reported in 2018.
Gwinnett, Newtown, and Rockdale Counties’ health departments are implementing a new model of care program, the Pregnancy Panel. Under this program, all women presenting at a clinic requesting a pregnancy test are tested for STIs, including HIV and syphilis. Regardless of STI status, pregnant patients receive case management from a member of the Infectious Disease team and linkage/referral to prenatal care.
The San Antonio Metropolitan Health District (SAMHD) will assess pregnancy intention, increase syphilis testing and ensure adequate treatment, and expand case management referrals and linkage to prenatal care services for 120 pregnant women. SAMHD will also utilize incentives to encourage women of childbearing age to get treated for syphilis. SAMHD will also conduct education sessions with local providers to increase syphilis testing and ensure adequate treatment.
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The National Association of County and City Health Officials (NACCHO) represents the nation’s nearly 3,000 local health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities. For more information about NACCHO, please visit www.naccho.org.