Welcome to 4 th Syphilis Report to the Community May 18, 2016
Syphilis and STDs in Bexar County Anil T. Mangla, MS, PhD, MPH, FRIPH Assistant Director of Health Syphilis Update to the Community May 18, 2016
Acknowledgements Cara J. Hausler, MPH, Senior Epidemiologist Jaseudia S. Killion, MPA, Public Health Associate Sian Hill, Program Manager Crystal Garza, Field Operations Manager DIS Rita Espinoza, MPH, DrPh(c), Chief Epidemiologist
Overview Review Data Gonorrhea Chlamydia Syphilis Review law for syphilis testing of pregnant women Activities
STDs in Bexar County
Chlamydia Cases, Bexar County, 2005-2015* 14,000 Cases 3 Year Moving Average (Cases) 12,000 10,000 Cases 8,000 6,000 4,000 7,400 7,594 8,054 8,849 10,440 11,455 11,828 11,409 11,340 11,127 13,313 2,000 0 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data (may contain duplicates) Source: local and central STD*MIS data, ranking from CDC
Chlamydia Rates, 2005-2015* Cases per 100,000 population 800 700 600 500 400 300 200 100 Bexar County Texas US 624 600 488 484 475 329 444 452 313 732 0 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data, using 2014 population estimates (may contain duplicates) Source: STD-MIS, Texas and CDC reports, using annual population estimates
TOTAL = 11,127 cases in 2014 29% = 3,207 unable to geo-code
Gonorrhea Cases, Bexar County, 2005-2015* 4,000 3,500 3,000 Cases 3 Year Moving Average (Cases) Cases 2,500 2,000 1,500 1,000 2,184 2,562 2,465 2,898 3,401 3,520 3,470 3,365 2,960 3,127 3,937 500 0 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data (may contain duplicates) Source: local and central STD*MIS data, ranking from CDC
Gonorrhea Rates, 2005-2015* Cases per 100,000 population 250 200 150 100 50 144 115 114 Bexar County Texas US 163 169 127 128 105 110 212 0 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data, using 2014 population estimates (may contain duplicates) Source: STD-MIS, Texas and CDC reports, using annual population estimates
TOTAL = 3,127 cases in 2014 29% = 912 unable to geo-code
Syphilis in Bexar County
Primary and Secondary Syphilis Cases, Bexar County, 2005-2015* 350 300 250 Cases 3 Year Moving Average (Cases) Cases 200 150 308 291 100 50 129 131 153 187 213 182 184 227 224 0 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data Source: local and central STD*MIS data, ranking from CDC
Primary and Secondary Syphilis Rates, 2005-2015* Cases per 100,000 Population 20 18 16 14 12 10 8 6 4 2 0 Bexar County Texas US 16.0 12.2 12.1 8.5 5.5 6.3 3.9 5.4 5.9 2.9 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data, using 2014 population estimates Source: STD*MIS data, Texas and CDC reports, using annual population estimates
Congenital Syphilis Rates in Texas Most Highly Populated Counties, 2012-2014 County 2012 Rates 2013 Rates 2014 Rates* Bexar 65.8 64.7 37.3 Harris 33.3 37.1 35.1 Tarrant 29.3 25.3 25.2 Dallas 10.3 15.5 12.9 These 4 counties account for 67% of the 70 cases of congenital syphilis in Texas in 2014. *Per 100,000 live births; 2013 live births used for calculation of 2014 rate. Source: Texas STD/HIV Program; Live births from Texas Health Data
Congenital Syphilis Cases, Bexar County, 2005-2016** Cases 20 18 16 14 12 10 8 6 4 2 0 Cases 3 Year Moving Average (Cases) 18 17 11 12 11 9 7 8 4 10 10 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14 '15* Year * Preliminary 2015 data ** Preliminary 2016 data as of 5-3-2016 Source: local and central STD*MIS data
Congenital Syphilis Rates, 2005-2015* Cases per 100,000 Live Births 80 70 60 50 40 30 20 10 0 27.4 63.4 37.3 16.3 20.5 18.1 8.2 Bexar County Texas US Healthy People 2020 Target 37.3 9.1 11.6 9.1 9.6 2005 '06 '07 '08 '09 '10 '11 '12 '13 '14+ '15*+ Year * Preliminary 2015 data; + Both 2014 and 2015 rates use 2013 live births Source: STD*MIS data, Texas and CDC reports, using annual population estimates
TOTAL = 925 cases in 2014 17% = 156 unable to geo-code
HIV, Syphilis and HBV Testing and Pregnancy: State Requirements for Texas Clinicians Texas law (Chapter 81.090 of the Texas Health and Safety Code) requires physicians or others permitted by law to attend a woman during pregnancy or at delivery to test her for human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV). She must be tested for HIV and syphilis at her first prenatal visit and during the third trimester. If no record of third trimester test results are available, expedited tests for HIV and syphilis must be conducted at delivery. Expedited HIV testing of infants at delivery is also required if a mother s results are undetermined. The law also requires pregnant women to be tested for hepatitis B at her first natal visit and at delivery. Source: Texas Department of State Health Services HIV/STD Program
HIV, Syphilis and HBV Testing and Pregnancy: State Requirements for Texas Clinicians Source: Texas Department of State Health Services HIV/STD Program
Why test pregnant women? Testing and treatment for HIV, HBV and syphilis prevents infected infants. Without knowledge of HIV status, a mother with HIV has an approximately 25% chance of transmitting HIV to her unborn child. If pregnant women with HIV are tested and receive appropriate care and treatment during pregnancy, labor, and delivery, and the newborn is treated as well, the transmission rate can be decreased to 2% or less. Testing and treatment also decreases rates of syphilis and HBV infection. Perinatal syphilis screening allowed Texas clinicians to identify 79 cases of congenital syphilis in 2012, enabling them to provide treatment and follow up. For infants born to women with infectious HBV, 70-95% will not be infected if they receive HBV vaccine and treatment within 12 hours of delivery. Source: Texas Department of State Health Services HIV/STD Program
Summary Gonorrhea and Chlamydia are increasing Syphilis and Congenital Syphilis continue to decline Efforts will be maintained and new collaborative efforts will be initiated
Prevention Strategies Targeted Prevention Partner Collaboration Mobile Unit
Mobile Unit
STD Mobile Clinic Schedule of Events Date Time Location Address May 19 10 am - 8 pm Mission Library South 3134 Roosevelt Ave, 78214 May 23 9 am 3 pm Mission Pharmacy Health Fair 3267 Roosevelt, 78214 May 24 10 am 8 pm Carver Library East 3350 E Commerce St, 78220 May 26 9 am 8 pm Henry Guerra Library(West) 7978 W Military Dr, 78227 June 4 11 am - 7 pm Family Pride 514 W Commerce St, 78207 June 9 10 am 6 pm Brook Hollow Library 530 Heimer Rd, 78232 June 16 10 am 8 pm Mission Library South 3134 Roosevelt Ave, TX 78214 June 18 9 am 1 pm AARC grand opening 303 N. Frio, 78207 June 25 5 pm 8 pm Adult Megaplex 11827 San Pedro Ave 78216 June 28 10 am 8 pm Carver Library East 3350 E Commerce St, 78220 June 30 11 am 8 pm Henry Guerra Library 7978 W Military Dr, 78227
210-207-8805 Anil T. Mangla, MS, PhD, MPH, FRIPH Assistant Director of Health 210-207-4237 Sian Hill Elmore Health Program Manager 210-207-8951 Crystal Garza Field Operations Manager