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Rapid Response to a Local Outbreak of Syphilis in Baltimore Joshua M. Michaud Epidemiologist Rapid Response to a Local Outbreak of Syphilis in Baltimore Joshua M. Michaud Epidemiologist Syphilis Elimination Project Johns Hopkins University School of Medicine

RRT Outbreak Response Steps 1. 2. 3. 4. 5. 6. 7. Identify “Hotspots” Form RRT Outbreak Response Steps 1. 2. 3. 4. 5. 6. 7. Identify “Hotspots” Form relationships with community Community Outreach Partner with community clinic RRT Screening outreach Monitoring, evaluating Termination

Critical Elements in Place • Assessment Form implemented November 2000 • Surrounding jurisdictions adopted Critical Elements in Place • Assessment Form implemented November 2000 • Surrounding jurisdictions adopted form December 2000 • Ongoing behavioral risk data collection • Ongoing Jail screening • Efforts to involve community

Anne Arundel Syphilis Interviews and Assessment Forms DECEMBER 2000 JANUARY 2001 • Dec 18: Anne Arundel Syphilis Interviews and Assessment Forms DECEMBER 2000 JANUARY 2001 • Dec 18: 3 primary male cases interviewed, all picked up >1 CSW on Patapsco Ave. • Dec 22: 1 secondary male case, picked up CSW on Patapsco Ave. • Jan 5: 1 primary male case, pick up on Patapsco • Jan 17: 1 secondary female case, CSW on Patapsco • Jan 23: 1 primary male case, pick up on Patapsco

December Syphilis Cases and Contacts in South Baltimore December Syphilis Cases and Contacts in South Baltimore

Informing and Involving the Community • “South Baltimore Syphilis Summit”-March 7, 2001 – Community Informing and Involving the Community • “South Baltimore Syphilis Summit”-March 7, 2001 – Community Based Organizations – Community Health Center – Police Department – City, County and State Health Departments

Outcomes of Syphilis Summit • Strengthened existing relationships with BCHD and community organizations • Outcomes of Syphilis Summit • Strengthened existing relationships with BCHD and community organizations • Introduced new players to Syphilis Elimination (e. g. Police Dept. ) • Identified clinical outreach site and outreach partners

Community Outreach • Outreach started April 11, 2001 – Bi-weekly outreach by DIS, 5: Community Outreach • Outreach started April 11, 2001 – Bi-weekly outreach by DIS, 5: 00 -7: 00 PM – 12 blocks of Patapsco Ave, adjoining streets – Distribute educational materials, referrals – Outreach Tips from Partner CBO – Health Department: “Get-to-know” the community – Community “Get-to-know” Health Department

Community Outreach Results April 11 – July 5, 2001 Total Number Contacted -Males -Females Community Outreach Results April 11 – July 5, 2001 Total Number Contacted -Males -Females -Transgender 353 171 160 1 Given STD literature, condoms, or both 94% Reported Interest in syphilis screening 21%

Screening Activity • June 7 -September 23, 2001 • Every Monday, Thursday 5: 00 Screening Activity • June 7 -September 23, 2001 • Every Monday, Thursday 5: 00 -7: 00 PM • Clinical Partner site nearby • Added incentive: Mc. Donald’s gift certificate

Screening Process • Consent obtained, intake performed • Blood draw, RPR and HIV test Screening Process • Consent obtained, intake performed • Blood draw, RPR and HIV test offered • Social Worker available for those in need of referral (Substance Abuse Treatment, Health Insurance, etc. ) • High-risk clients given 2 g Azithromycin as preventative treatment • Return in 1 week for results

RRT Screening Outcomes June 7 -September 24, 2001 RRT Screening Outcomes June 7 -September 24, 2001

Screening Client Demographics (n=69) Mean Age -Males -Females 33 30 Gender -Male -Female 39 Screening Client Demographics (n=69) Mean Age -Males -Females 33 30 Gender -Male -Female 39 (56. 5%) 30 (43. 5%) Race -Black -White -Unknown 40 (58. 0%) 27 (39. 1%) 2 (2. 9%)

Risk Behavior Profile of Clients by Self-report (n=69) Risk % reporting Exchange sex for Risk Behavior Profile of Clients by Self-report (n=69) Risk % reporting Exchange sex for drugs 32 Substance Abuse (Cocaine or Heroin) 60 Sex with symptomatic 3 MSM 3

Profile of Positives HIV+ n=3 Syphilis+ n=5 Females 2 3 Sex for drugs 2 Profile of Positives HIV+ n=3 Syphilis+ n=5 Females 2 3 Sex for drugs 2 4 Substance Abuse 2 4 Previously Undetected 1(? ) 2 Probable Re-infection - 1 Characteristic

Brooklyn/Anne Arundel Syphilis Cluster SB, Aug 2 DO, Dec 18 RY, Jul 16 MH, Brooklyn/Anne Arundel Syphilis Cluster SB, Aug 2 DO, Dec 18 RY, Jul 16 MH, Dec 22 PB, Jul 19 TC, Jun 28 EC, Aug 20 DB, Jul 2 SB Open FR DC, Aug 20 WA, Aug 16 SA, Aug 16 KS, Jun 7

Conclusion • Preliminary analysis: outreach effort successful in finding infected persons from high-risk groups Conclusion • Preliminary analysis: outreach effort successful in finding infected persons from high-risk groups • This methodology currently being implemented in the next “Hotspot”— Penn-North