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5C1 Identifying Missed Opportunities for Prevention: Congenital Syphilis Case Review, California Project Area, 2007-2014

Friday, September 23, 2016: 8:00 AM
Salon D
Julie Stoltey, MD, MPH1, Rilene Ng, MPH2, Colleen C. Denny, MD3, Ina Park, MD, MS2 and Heidi Bauer, MD, MS, MPH1, 1STD Control Branch, California Department of Public Health, Richmond, CA, 2Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA, 3University of California, San Francisco, San Francisco, CA

     

Background:  Between 2012 and 2014, congenital syphilis (CS) cases in California increased from 30 to 100.  CS is of high public health importance because it can cause devastating outcomes and is preventable with proper treatment. We sought to characterize CS cases and identify missed opportunities for prevention.

Methods:  California law mandates syphilis reporting to local health departments (HD); cases are investigated and entered into the California Project Area (CPA, excluding Los Angeles and San Francisco) STD surveillance system. CS cases born 2007-2014 in the CPA were included based on the 2013 Centers for Disease Control and Prevention CS algorithm, and were matched to maternal syphilis cases. Infant characteristics, maternal demographics, prenatal care (PNC), clinical, and HD factors were examined.

Results:  From 2007-2014, 249 CS cases met criteria for analysis; there were 234 (94%) probable cases and 15 (6%) stillbirths. Most mothers with infants with CS had late syphilis (n=147, 59%), were age 20-29 (n=141, 57%), and were Hispanic (n=135, 54%). Only 51 (21%) women accessed PNC in the first trimester, 39 (16%) in second trimester, 42 (17%) in third trimester, and 87 (35%) had no PNC. Of 90 mothers who accessed PNC in 1st/2nd trimester, 68 (76%) were tested ≥30 days prior to delivery. Of those, 28 (41%) had reactive syphilis serology ≥30 days prior to delivery; treatment status was delayed/inadequate (n=11), none (n=7), unknown (n=5), and adequate (n=5). Of 90 mothers with early syphilis, 47 (52%) were interviewed within 14 days of assignment; 24 (27%) were not interviewed.

Conclusions:  Most mothers who gave birth to infants with CS had late syphilis and lacked timely PNC. Testing was frequently delayed/absent, treatment was frequently delayed/inadequate, and there were challenges in HD follow-up. CS prevention requires state and local collaboration to optimize surveillance systems, clinical services, disease investigation/partner services, communications, and partnerships.

See more of: Congenital Syphilis and Other Perinatal STD Complications
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