The Role of Disease Intervention Specialists in the Prevention of Congenital Syphilis

Background:  According to the CDC, congenital syphilis rates increased by 38 percent between 2012 and 2014, from 334 to 458 cases.  Indianapolis has had only 1 case of congenital syphilis from 2011 -2015 despite having the majority of syphilis morbidity in the state. We hypothesized that this was due to Disease Intervention Specialists (DIS) who played a major role in prevention.

Methods:  All cases of pregnant women with positive non-treponemal tests reported by electronic laboratory reports and communicable disease reports from 2011-2015 were reviewed using data entered into the Indiana Statewide Investigating and Monitoring Surveillance System (SWIMSS) by DIS and surveillance personnel in the course of case investigations.   Women with positive syphilis confirmatory tests identified as syphilis morbidity were further examined to determine their disposition and what DIS activity was done on each case. 

Results:  A total of forty-eight females were tested and found to have a positive non-treponemal test for syphilis during their pregnancy.  Of these, 21 were found to be not infected because they had a negative treponemal confirmatory test or a previous history of treated syphilis leaving 27 pregnant women with syphilis of which 4 were secondary cases, 12 were early latent cases and 11 late latent cases by current definitions.  Of these, DIS interviewed 23 of the 27 cases.  20 out of the 27 cases were infected and brought to treatment.  Four others were treated prior to DIS contact. 

Conclusions:  DIS intensely followed up with each individual - making phone calls to providers and patients, conducting field investigative activities, and providing partner services. Some cases involved several hours of persistence in order to assure that these women and all of their partners were treated.  Had it not been for DIS intervention, 74% of the women may not have been treated adequately in order to stop transmission to their infants underscoring the importance of DIS in congential syphilis prevention.