Background:
In 2003, reported cases of CS increased dramatically from an average of 8 per year from 1999 to 2002 to 20 in 2003.Epidemiologic investigation of cases revealed an increasing proportion among international adoptees and infants born to recent immigrants.

Objective:
To describe the epidemiologic and social context of imported CS in 2003.

Method:
The NYS CS registry, case management system and case narratives prepared by disease intervention specialists (DIS) were used to describe the epidemiologic characteristics of CS cases and to assess qualitative factors influencing CS outcomes.

Result:
Of 20 CS cases, five (25%) occurred among international adoptees and 8 (40%) among infants born to women who had immigrated within the year. Of these infants, three were clinical cases, including two stillbirths. Among adoptees, inadequate documentation of biologic mother's syphilis history led to CS diagnosis. DIS intervention to ensure adequate CS management was necessary due to adoption agency physicians' lack of knowledge of syphilis treatment guidelines. Among immigrant CS, causal factors were lack of prenatal care (25%), no syphilis test in pregnancy (25%) or treatment < 30 days before delivery (50%). Language barriers, lack of transportation and fear of job loss contributed to poor health care seeking behavior.

Conclusion:
CS cases were attributed to inadequate adoption documentation; International adoption policies should include mandatory documentation of the biological mother's medical history. Furthermore, social and situational factors that limited health care seeking behavior among recent immigrants contributed to CS.

Implications:
Participants will understand the complex epidemiologic and social characteristics of congenital syphilis in NYS and how such outcomes affected CS prevention and policy.