1. How Community, Corrections, Neighboring Jurisdictions, and Surveillance Worked Together to Contain an Outbreak of Syphilis in Baltimore City

2. Background In 1997, Baltimore City had highest rates of early syphilis In 1998, CDC funded Baltimore City Syphilis Elimination Program (SEP) Goals of Baltimore City SEP: –Evaluate and improve syphilis surveillance system –Develop and expand partnerships –Develop and implement an outbreak response plan –Involve partners in plan

3. Progress Epidemiology has changed –Rates of syphilis in Baltimore –Syphilis more concentrated in populations who fail to seek care Evaluated, improved, and enhanced surveillance Developed Rapid Response Plan with new partners including community, corrections, neighboring jurisdictions

4. Progress (continued) Funded community-based organizations (CBOs) to expand prevention and clinical focus to syphilis Conducted first rapid response to outbreak in South Baltimore with new partners Initiating rapid response to outbreak in West Baltimore

5. Presentations Changing epidemiology of syphilis (J. Ellen, S. Bonu, J. Michaud, J. Zenilman and A. Rompalo ) Enhanced surveillance (S. Tulloch) Development of the rapid response plan-the Syphilis Elimination Plan Working Group (S. Johnson) CBOs funded by SEP (K. Robinson) Implementation of the rapid response plan in a local outbreak of syphilis (J. Michaud)

6. Changing Epidemiology and Sexual Networks During and After the Syphilis Epidemic in Baltimore City

7. Trends: Syphilis Cases

8. Congenital Syphilis Cases by Quarter, 1997-2001

9. What changed?

10. Community and Associated Network Factors Linked to Declining Syphilis Community FactorsNetwork Factors Decreased crack cocaine use Decreased frequency of microstructures Fewer disruptions in housing Fewer connections between periphery and core Improved public health services Decreased prevalence

11. Objective To compare structural characteristics of sexual networks in Baltimore City during and after the 1997-1998 epidemic

12. Methods Used STD*MIS data for 1997-2000 : –Original partner interviews –Contact field records Identified largest component spanning all years Examined structural changes in component during (1997-1998) and after (1999-2000) epidemic Used UCINET and Pajek to conduct analyses

13. Rank Order of Components Based on Number of Nodes

14. Largest Component All Years: N=1103

15. Largest Component During Epidemic 1997-1998: N=148

16. Largest Component After Epidemic 1999-2000: N=98

17. Characteristics of Component 1997-19981999-2000 Average distance1.81.2 2-clique (n=3)4632 3-plex (n=2)1205333 Density.006.01

18. What Changed and What Does It Mean? –Smaller overall distances and greater density between nodes More concentrated geographically –Fewer microstructures Fewer hot spots and core transmitters harder to find

19. Conclusion With declining rates, need to work even harder and be more aggressive to find cases and reduce rates further The collaboration between community, corrections, neighboring jurisdictions, and Baltimore City Health Department is essential to syphilis elimination