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

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

3. 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

4. Anne Arundel Syphilis Interviews and Assessment Forms DECEMBER 2000JANUARY 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

5. December Syphilis Cases and Contacts in South Baltimore

6. 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

7. 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

8. Community Outreach Outreach started April 11, 2001 –Bi-weekly outreach by DIS, 5:00-7:00PM –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

9. Community Outreach Results April 11 – July 5, 2001 Total Number Contacted353 -Males -Females -Transgender 171 160 1 Given STD literature, condoms, or both 94% Reported Interest in syphilis screening 21%

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

11. 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 2g Azithromycin as preventative treatment Return in 1 week for results

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

13. Screening Client Demographics (n=69) Race -Black -White -Unknown 40 (58.0%) 27 (39.1%) 2 (2.9%) Mean Age -Males -Females 33 30 Gender -Male -Female 39 (56.5%) 30 (43.5%)

14. Risk Behavior Profile of Clients by Self-report (n=69) Risk% reporting Exchange sex for drugs32 Substance Abuse (Cocaine or Heroin) 60 Sex with symptomatic 3 MSM3

15. Profile of Positives Characteristic HIV+ n=3 Syphilis+ n=5 Females23 Sex for drugs24 Substance Abuse24 Previously Undetected1(?)2 Probable Re-infection-1

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

17. 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