Background:
As of October 1, 2007, 56 cases of syphilis have been reported among members of the Tohono O'Odham tribe in Arizona compared to 1 case in 2005, and 8 cases in 2006. Demographics and risk factors are different than other syphilis case patients in Arizona, many of the cases occurring among Native American youth. Managing an outbreak on a rural reservation poses unique challenges and offers many opportunities to collaborate with tribal, local, state, county, and federal partners.

Objective:
1. How to establish STD outbreak threshold levels for American Indian populations.
2. Describe the epidemiology of the outbreak.
3. Describe the surveillance efforts necessary in managing an outbreak on a rural reservation.

Method:
Epidemiologic data reported from laboratories and surveillance data wre used to determine the outbreak. Data sharing strategies were developed between the Tribe and IHS. Education, assistance with surveillance, and case investigations were prioritized.

Result:
Multiple presentations to medical staff, public health nurses, and community health liaisons were conducted. Assistance for case investigations and surveillance provided. Data sharing agreements are in place between partners. Partners participate in regularly scheduled task force meetings to continue to identify opportunities and challenges in the management of the outbreak. An epidemiologic profile was developed.

Conclusion:
Collection of data, epidemiologic review and case surveillance are vitally important in building an outbreak plan. Capacity development and working collaboratively with all partners can be challenging, but is necessary in managing an outbreak on a rural reservation.

Implications:
Declaration of an outbreak on a rural reservation needs to be managed with all partners involved and very good communicaton between those partners.