An Evaluation of Syphilis Outbreak Response Plans, 2005-2006

Background:
STD Project Areas (PAs) receive CDC funding via the Comprehensive STD Prevention Systems (CSPS) grant, which requires a syphilis outbreak response plan (ORP). Since 2001, syphilis rates have increased yearly in the United States and several outbreaks have occurred, but no systematic review of ORPs has been conducted.

Objective:
To summarize the characteristics of ORPs included in CSPS applications submitted to CDC in 2005-2006 from the 40 PAs who receive supplemental funding for syphilis elimination (SE) activities.

Method:
An abstraction form was developed to assess 33 quantitative items in four categories: syphilis outbreak detection, investigation, response, and evaluation. Key components of a well-defined threshold for outbreak detection include specified syphilis stages, a geographic unit, number of cases reported within a defined time period, syphilis rates, and reported cases in a baseline period. Data were abstracted from information in the ORP, Executive Summary, and SE sections of the PAs' CSPS applications.

Result:
Of 39 PAs with an ORP, 36 (92%) stated that data trends were reviewed regularly, usually monthly (26/39). Syphilis outbreak threshold definitions were included in 35 ORPs; however, only ten (29%) included at least four of the key threshold components. A designated outbreak response team was described in 29 (74%) ORPs; 27 teams were interdisciplinary. Twenty-nine (74%) PAs reported tailoring responses or interventions to affected populations. Fourteen (36%) PAs schedule a review of their ORP.

Conclusion:
Most ORPs included regular data reviews, interdisciplinary outbreak response teams, and tailored interventions, but few had well-defined outbreak thresholds or scheduled reviews of their ORP.

Implications:
All SE PAs should have an updated comprehensive ORP that includes well-defined thresholds and a scheduled review.