1. Enhanced Syphilis Surveillance in Baltimore Scott Tulloch Maryland State Department of Health and Mental Hygiene

2. 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

3. 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

4. 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

5. Local Use Variables

6. Local Use Variables from Interviews Apr. 2001 – Jan. 2002 (n=120) Risk Male (n=67) Female (n=53) MSM7 (10%)- Exchange Drugs1 (2%)0 Exchange Money22 (33%)7 (13%) Exchange Drugs and Money 1 (2%)4 (8%) Used Heroin/Crack12 (18%)18 (34%)

7. 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

8. 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

9. Assessment Form -Focuses on where cases met their sex partners -Scanned into a database -Places and risks are mapped using GIS software

12. Sex Partner Meeting Places (n=55) Street/Corner53% Private residence13% Bar/club9% Strip club6% Workplace/office4% Park4% Other/Unknown13%

13. Stat Lab Project Jail-based rapid disease intervention initiative Prevalence monitoring of high-risk population Partnering with local SE activities

14. Syphilis Reactor Prevalence (in%) At Baltimore City Jail By Sex and Quarter, 1998-2001

15. Percentage of Baltimore City P&S Syphilis Identified By Jail-Based Screening By Year (1999-2001)

16. Associated Risk Factors for P&S Syphilis Cases Identified by Jail-Based Screening (2001) RiskNumber of Cases with Identified Risk Factor (n=30) Sex for Drugs/Money18 (60%) IDU8 (27%) Cocaine/Crack Use12 (40%) MSM0

17. 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

18. 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

19. Conclusion Creating an effective “tool” –Multi-pronged approached –Representative Data supported interventions Community Involvement –Community