# Presentation: 683351

## How Community, Corrections, Neighboring Jurisdictions, and Surveillance Worked Together to Contain anOutbreak of Syphilis in Baltimore City

## Background

- In 1997, Baltimore City had highest rates of early syphilis
- In 1998, CDC funded Baltimore City Syphilis Elimination Program (SEP)
- Goals of Baltimore City SEP:
- Evaluate and improve syphilis surveillance system
- Develop and expand partnerships
- Develop and implement an outbreak response plan
- Involve partners in plan

## Progress

- Epidemiology has changed
- Rates of syphilis in Baltimore
- Syphilis more concentrated in populations who fail to seek care
- Evaluated, improved, and enhanced surveillance
- Developed Rapid Response Plan with new partners including community, corrections, neighboring jurisdictions

## Progress (continued)

- Funded community-based organizations (CBOs) to expand prevention and clinical focus to syphilis
- Conducted first rapid response to outbreak in South Baltimore with new partners
- Initiating rapid response to outbreak in West Baltimore

## Presentations

- Changing epidemiology of syphilis (J. Ellen, S. Bonu, J. Michaud, J. Zenilman and A. Rompalo )
- Enhanced surveillance (S. Tulloch)
- Development of the rapid response plan-the Syphilis Elimination Plan Working Group (S. Johnson)
- CBOs funded by SEP (K. Robinson)
- Implementation of the rapid response plan in a local outbreak of syphilis (J. Michaud)

## Changing Epidemiology and Sexual Networks During and After the Syphilis Epidemic in Baltimore City

## Trends: Syphilis Cases

## Congenital Syphilis Cases by Quarter, 1997-2001

## What changed?

## Community and Associated Network Factors Linked to Declining Syphilis

| Community Factors | Network Factors |
| --- | --- |
| Decreased crack cocaine use | Decreased frequency of microstructures |
| Fewer disruptions in housing | Fewer connections between periphery and core |
| Improved public health services | Decreased prevalence |

## Objective

- To compare structural characteristics of sexual networks in Baltimore City during and after the 1997-1998 epidemic

## Methods

- Used STD*MIS data for 1997-2000 :
- Original partner interviews
- Contact field records
- Identified largest component spanning all years
- Examined structural changes in component during (1997-1998) and after (1999-2000) epidemic
- Used UCINET and Pajek to conduct analyses

## Rank Order of Components Based on Number of Nodes

##  Largest Component All Years: N=1103

## Largest Component During Epidemic 1997-1998: N=148

## Largest Component After Epidemic 1999-2000: N=98

## Characteristics of Component

|  | 1997-1998 | 1999-2000 |
| --- | --- | --- |
| Average distance | 1.8 | 1.2 |
| 2-clique (n=3) | 46 | 32 |
| 3-plex (n=2) | 1205 | 333 |
| Density | .006
 | .01 |

## What Changed and What Does It Mean?

- Smaller overall distances and greater density between nodes
- More concentrated geographically
- Fewer microstructures
- Fewer hot spots and core transmitters harder to find

## Conclusion

- With declining rates, need to work even harder and be more aggressive to find cases and reduce rates further
- The collaboration between community, corrections, neighboring jurisdictions, and Baltimore City Health Department is essential to syphilis elimination