Battling Congenital Syphilis in Louisiana

Chaquetta Johnson, DNP, MPH, APRN, WHNP-BC

Deputy Director, STD/HIV Program

Louisiana Department of Health - Office of Public Health

Louisiana

Louisiana

2016 STD Surveillance State Rankings

Chlamydia – 2nd – 31,727 cases, 679.3 per 100,000

Gonorrhea – 2nd – 10,782 cases, 230.8 per 100,000

P&S Syphilis – 1st – 750 cases , 16.1 per 100,000

Congenital syphilis – 1st – 48 cases – 74.4 per 100,000

Congenital Syphilis in Louisiana 2016

Congenital Syphilis Louisiana 2007-2016

37

24

11

33

18

32 40

46 54

48

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2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Congenital Syphilis Rates Louisiana and the US, 2007-2016

In 2015, Louisiana reported 54 CS cases

In 2015, Louisiana ranked 1st in the US for CS case rates (83.9 cases per100,000 live births); 6x the national rate of 12.4 cases per 100,000 livebirths

In 2016, Louisiana had 48 CS oddslot cases

Louisiana’s CS case rate decreased to 75.2 cases per 100,000 live births in2016

Louisiana Department of Health Office of Public Health (OPH) regions

Congenital Syphilis Cases Geographic Distribution by OPH regions, 2016

Congenital Syphilis in Louisiana, 2016

Every Public Health Region reported at least one case of congenital syphilis

59% of CS cases occurred in three regions: Regions 2 (Baton Rouge), Region 7 (Shreveport), and Region 8 (Monroe)

90% of mothers were Black

69% of mothers were <25 years of age at the time of delivery

27% of mothers had no or untimely prenatal care (prenatal care initiated at least 2 months before delivery)

17% who did receive timely prenatal care did not have timely syphilis screening (at least 45 days before delivery)

Battling Congenital Syphilis in Louisiana In 2016, Louisiana STD/HIV Program implemented the STD/HIV

Reduction Strategy

Direct Care Service

Increased STD screening and testing statewide

Patient Awareness & Education

Louisiana Health Hub: www.louisianahealthhub.org

Community Awareness & Engagement

Each OPH region has an operational STD/HIV Regional Task Force

Congenital Syphilis Reduction was a top priority for the State, the Program and the Reduction Strategy

Battling Congenital Syphilis in Louisiana Congenital Syphilis Case Review Implemented a formal CS Regional Case Review process

Initiated as a part of STD AAPPS activities: As a high morbidity state: “Assess congenital syphilis cases to determine

the epidemiological and health care factors associated with the cases to inform interventions”

Case Review Teams are comprised of Central Office staff, OPH Regional Medical Team leadership, DIS Regional staff

Case reviews were initially held monthly; now hosted quarterly to increase timeliness of feedback and opportunities for intervention

Louisiana Congenital Syphilis Regional Case Review Parish of residence

Prenatal Care

Delivering Hospital/Provider

Syphilis testing in 1st & 3rd Trimester

Stage of Disease

Treatment – Facility, Adequacy, Start Dates

Infant – DOB, testing, treatment (if available)

Partner services - Treatment/follow-up

Louisiana Congenital Syphilis Case Review Findings

Lack of repeat/third trimester testing of syphilis among pregnant women

Inadequate treatment for women diagnosed with syphilis during pregnancy

Late/no initiation of prenatal care

Lack of patient/partner education regarding STIs and safe sex practices during pregnancy to prevent late pregnancy infection/re-infection

Need for increased communication between Regional DIS staff and Regional Medical Directors during case investigations for pregnant women diagnosed with syphilis

HIV/Syphilis During Pregnancy Reporting Form

• Testing

• Act 459 Third Trimester HIV and Syphilis Testing Law

• Louisiana law requires opt-out testing for all women during 1st trimester of pregnancy, 1st prenatal visit in 3rd trimester and at delivery (if testing/status is not noted in her medical charts)

• New HIV/Syphilis During Pregnancy Report Form • Intended to improve reporting of HIV and syphilis during pregnancy • Previously only used Adult Case Report Form • Streamlines the reporting process • Online: http://dhh.louisiana.gov/index.cfm/page/1019

• Opportunity to identify high risk pregnancies before mother gives birth

• Improves prevention outreach efforts

• Gives more information to the STD/HIV Program about the mother’s needs, if any

Through our DIS and Linkage to Care Coordinators, SHP has the ability to connect a women who has unmet needs to the care and services necessary in order to have a healthy pregnancy and reduce MTCT of HIV or syphilis

Battling Congenital Syphilis in Louisiana Tripled syphilis screening across the state using rapid syphilis

testing technology In 2016, 93.5% of primary and secondary syphilis cases were

treated within 14 days of specimen collection at Parish Health Units (PHUs); an increase from 78.6% in 2015

Provider Alert Letters were widely distributed to physician and nursing organizations through email list serves and license renewal notices

Shared Regional geocoded maps with the Regional Medical Directors/Regional Task Forces depicting primary and secondary syphilis infections to assist with targeted education and intervention efforts

Congenital Syphilis in Louisiana What’s Next?

Enhanced Congenital Syphilis Response grant

Expand our CS case review teams to include representation from Medicaid and the OPH Bureau of Family Health

Develop a CS case management model that will be piloted in two high morbidity regions (Baton Rouge and Shreveport)

Host two Congenital Syphilis conferences that will focus on clinical and community partnership to reduce congenital syphilis

Closer collaboration with Medicaid to advocate for third trimester testing (Medicaid Quality Committee & OB Subcommittee)

Collaboration with community partners focused on improving birth outcomes to incorporate congenital syphilis prevention in their messaging and efforts (Tulane University & March of Dimes)

Congenital Syphilis Louisiana 2007-2016

37

24

11

33

18

32 40

46 54

48

0

10

20

30

40

50

60

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Num

ber

of C

ases

Year of Diagnosis

Goal = Happy, Healthy Babies in Louisiana!

Acknowledgements

Ashley Hoover, SHP Perinatal Surveillance Supervisor

Jessica Fridge, SHP Surveillance Manager

Congenital Syphilis Case Review Team members

Chaquetta Johnson, DNP, MPH, APRN, WHNP-BC Deputy Director, STD/HIV Program

Louisiana Department of Health/Office of Public Health

Chaquetta.Johnson@la.gov