5 research outputs found
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The Sacred Cow of Syphilis Control: Assessing the Utility and Practical Implications of Syphilis Partner Services Data in California
Following the introduction of penicillin in the 1940s, the incidence of infectious syphilis in the United States dramatically declined from a high of 70.9 per 100,000 in 1946 to a historic low of 2.1 in 20001. In the decade since, syphilis has shown signs of re-emergence, with the incidence rate of infectious syphilis in the U.S. increasing to 5.5 per 100,000 in 2013. Infectious syphilis trends in California have largely paralleled those of the rest of the country, but with an incidence rate consistently above the national average. After decades of substantial progress in syphilis control, the incidence of infectious syphilis in California increased from a low of 0.9 per 100,000 (284 cases) in 1999 to 9.3 in 2013 (3,554 cases)2. As in other major metropolitan areas in the U.S., the majority of syphilis cases in California are among men who have sex with men (MSM), with a high proportion reporting HIV co-infection. Syphilis infection can result in major health complications if untreated, and also facilitates the transmission and acquisition of HIV3-5. In addition to mandated reporting to health departments, syphilis partner services – in particular, partner notification - are a standard public health practice for identifying potentially infectious individuals for testing and treatment, thereby interrupting transmission of syphilis within sexual networks and reducing incidence of the illness in the general population6. However, the increasing incidence of syphilis in California, the frequent reporting by patients with syphilis of anonymous sex partners, and the lack of a clear measure of partner services effectiveness raise questions concerning the impact this intervention is having on spread of disease, and to what extent the data acquired through syphilis partner services provide meaningful information about how the underlying sexual networks contribute to trends in syphilis morbidity in various populations. The objectives of this dissertation are 1) to review studies evaluating syphilis partner notification efforts and compare outcome definitions and measures of effectiveness, 2) to analyze the structure and characteristics of sexual networks detected through routine syphilis surveillance and partner notification efforts in the San Francisco Bay Area Region, and 3) to make recommendations concerning how public health departments might use syphilis surveillance data to better understand such networks and to provide opportunities for case-finding and disease prevention. This dissertation will directly inform a common public health intervention by assessing the utility of existing public health data for understanding and preventing transmission of syphilis within networks, and by discussing ways in which resources might be deployed to reduce the incidence of syphilis more effectively
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Contact-Tracing Outcomes Among Household Contacts of Fully Vaccinated Coronavirus Disease 2019 (COVID-19) Patients: San Francisco, California, 29 January-2 July 2021.
BackgroundThe extent to which vaccinated persons diagnosed with coronavirus disease 2019 (COVID-19) can transmit to other vaccinated and unvaccinated persons is unclear.MethodsUsing data from the San Francisco Department of Public Health, this report describes outcomes of household contact tracing during 29 January-2 July 2021, where fully vaccinated patients with COVID-19 were the index case in the household.ResultsAmong 248 fully vaccinated patients with breakthrough infections, 203 (82%) were symptomatic and 105 were identified as the index patient within their household. Among 179 named household contacts, 71 (40%) contacts tested, over half (56%) were fully vaccinated and the secondary attack rate was 28%. Overall transmission from a symptomatic fully vaccinated patient with breakthrough infection to household contacts was suspected in 14 of 105 (13%) of households. Viral genomic sequencing of samples from 44% of fully vaccinated patients showed that 82% of those sequenced were infected by a variant of concern or interest and 77% by a variant carrying mutation(s) associated with resistance to neutralizing antibodies.ConclusionsTransmission from fully vaccinated symptomatic index patients to vaccinated and unvaccinated household contacts can occur. Indoor face masking and timely testing of all household contacts should be considered when a household member receives a positive test result in order to identify and interrupt transmission chains
Sex, Drugs (Methamphetamines), and the Internet: Increasing Syphilis Among Men Who Have Sex With Men in California, 2004–2008
Unnamed Partners From Syphilis Partner Services Interviews, 7 Jurisdictions.
BackgroundReducing transmission depends on the percentage of infected partners treated; if many are missed, impact on transmission will be low. Traditional partner services metrics evaluate the number of partners found and treated. We estimated the proportion of partners of syphilis patients not locatable for intervention.MethodsWe reviewed records of early syphilis cases (primary, secondary, early latent) reported in 2015 to 2017 in 7 jurisdictions (Florida, Louisiana, Michigan, North Carolina, Virginia, New York City, and San Francisco). Among interviewed syphilis patients, we determined the proportion who reported named partners (with locating information), reported unnamed partners (no locating information), and did not report partners. For patients with no reported partners, we estimated their range of unreported partners to be between one and the average number of partners for patients who reported partners.ResultsAmong 29,719 syphilis patients, 23,613 (80%) were interviewed and 18,581 (63%) reported 84,224 sex partners (average, 4.5; 20,853 [25%] named and 63,371 [75%] unnamed). An estimated 11,138 to 54,521 partners were unreported. Thus, 74,509 to 117,892 (of 95,362-138,745) partners were not reached by partner services (78%-85%). Among interviewed patients, 71% reported ≥1 unnamed partner or reported no partners; this proportion was higher for men who reported sex with men (75%) compared with men who reported sex with women only (65%) and women (44%).ConclusionsApproximately 80% of sex partners were either unnamed or unreported. Partner services may be less successful at interrupting transmission in networks for men who reported sex with men where a higher proportion of partners are unnamed or unreported