142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Using Descriptive and Multivariate Analysis to Understand an Increase in Congenital Syphilis within an Incident Command Structure

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Yvette Rivero, MPH , Florida Department of Health in Broward County, Fort Lauderdale, FL
The Florida Department of Health in Broward County activated an Incident Command Team (ICT) to respond to an increase in incidence of infectious and congenital syphilis cases in calendar year 2012.  Infectious Syphilis cases in Broward County are high compared to the State of Florida and National data.  Congenital syphilis cases in Broward County rose from 0 in 2010 to 10 in 2011 and 15 in 2012. The ICT established objectives to: conduct targeted epidemiological investigation and study, including retrospective analysis; implement continuous quality improvements to STD program activities; manage internal and external strike teams; recruit and train a competent STD program work force; develop and implement a social marketing program; conduct provider and community outreach and education; and, monitor the effectiveness of mitigation strategies and campaign activities. 

ICT meetings were held from May 30, 2013, through January 2, 2014.    The initial Incident Action Plan (IAP) was prepared on May 30, 2013. A total of 22 IAPs were developed over the course of the event. A total of 46 Situation Reports were developed.   An electronic survey was distributed to the eleven incident command team members with a final After Action meeting held on March 13, 2014. This activation also allowed DOH-Broward to test its All-Hazards Response Plan and Communications and Epidemiology Annexes in a real world event scenario.

A descriptive analysis of the characteristics of mothers of live infants with congenital syphilis in Broward County, Florida from 2007 – 2012 was developed utilizing a data set of all sexually transmitted diseases reported from 2007 through 2012 in Broward County.  For missing variables, the data set was supplemented with information extracted from the narrative section of reported cases in PRISM. Other databases such as Florida Shots, Vital Statistics, Man Driver and Vehicle Express (MDAVE), and Health Management System were also searched. Attempts were also made to contact clients. The trimester of prenatal test was calculated using the pregnancy wheel and the estimate date of delivery.

An analysis of syphilis trend data was also developed for the period 2007 – 2012.  Maps were developed depicting congenital syphilis, infectious syphilis and HIV cases occurring in calendar year 2012.  A GIS map overlay of calendar year 2012 chlamydia, gonorrhea and syphilis cases was also developed.  The analysis and mapping assisted the Incident Command Team to understand the incidence and the geographic concentration of cases to develop targeted strategies for prevention and education activities.

The Incident Command System provided an effective structure to manage, track, document, and evaluate a non-emergency response.  New congenital syphilis cases were reduced by 40% from 2012 to 2013.  An integrated team of STD, TB, Hepatitis, HIV and Epidemiology professionals meet bi-weekly to continue coordinated and integrated program discussions.

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control
Public health or related education

Learning Objectives:
Demonstrate how descriptive and multivariate analysis assist in understanding an increase in congenital syphilis; Describe how an Incident Command Team may be utilized to manage non-emergency response activities. Define quality improvements to STD program activities; Design provider and community outreach and education strategies based on epidemiological assessments; and, evaluate effectiveness of mitigation strategies and campaign activities.

Keyword(s): Epidemiology, STDs/STI

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Earned my Masters in 2009. Articulate leader, well versed in developing strategic roadmaps in collaboration with senior leadership to develop, plan and implement innovative solutions to exceed levels of patient care and management. Have applied changes in laws, policies and research to the development of protocols in HIV CARE that have trained many medical providers in the field. Perinatal Prevention Director serving a county population of 1.8 million residents with high rates of STD's/HIV.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.