Syphilis outbreak in Fresno County: Hear why federal CDC was called in
Fresno County syphilis cases are soaring – even though the sexually transmitted disease was nearly nonexistent here six years ago – which has led county health officials to seek help from state and federal officials.
Medical workers from the federal Centers for Disease Control and Prevention have joined the county’s staff and the state Department of Public Health-Sexually Transmitted Disease Control Branch in seeking solutions to the county’s syphilis crisis, which may be linked to drug use and prostitution.
Syphilis is contracted through sexual activity and can lead to serious rashes and potentially significant nervous system ailments in adults. Congenital syphilis can lead to death in newborns and serious maladies for infants, including blindness.
Treating infants for congenital syphilis could require as few as one shot and as many as three injections that are 98 percent effective if expectant mothers get the antibiotic drug bicillin at least a month before their baby is born.
Fresno County’s surging problem exceeded every other county in California in 2015, state officials say. And the federal government’s engagement in the battle shows the seriousness of the situation.
“We don’t do this frequently,” said Dr. Sarah Kidd, a medical epidemiologist with the CDC in Atlanta. “Fresno County and the state reached out to us.”
This is clearly an extremely urgent situation in this county that must be addressed immediately.
Ken Bird, Fresno County health officer
In 2014, Kern County had the highest per-capita rate of congenital syphilis in California with 18 cases, the same number as Fresno County. The following year, Fresno County’s cases soared to at least 35 and possibly as high as 40 (the actual number remains under investigation). In California, 100 cases were investigated in 2014. Official state numbers for 2015 aren’t yet available.
By contrast, Los Angeles County, with 10 times Fresno County’s population, had 31 cases in 2014 and 23 in 2015, according to state health officials. Kern jumped to 22 in 2015. Other Valley areas showing significant increases in 2015 were Stanislaus and San Joaquin counties. But in some areas, the number of cases declined: Kings County had one case last year after two in 2014, and Tulare County fell from four cases to one. Madera had none.
“This is clearly an extremely urgent situation in this county that must be addressed immediately,” said Dr. Ken Bird, Fresno County’s health officer.
Congenital syphilis can cause premature birth, fetal death, early infant mortality and can damage infants’ vision, hearing, heart and nervous systems.
“It’s a devastating illness and entirely preventable,” Bird said. “We shouldn’t be seeing infants born with syphilis.”
Primary and secondary cases of syphilis, early stages of the disease in teens and adults, have gone from a rate of two per 100,000 population in 2010 to 12 per 100,000 in 2014. That rate increased to 15 per 100,000 last year, a 25 percent rise in one year.
“The number of cases has been steadily, almost exponentially, increasing,” said Bird.
The state places Kings County second only to Fresno County as having the highest rate of women with early stages of syphilis.
Health Officer Dr. Michael MacLean said his department is focusing on women of child-bearing age even though only one child was born with congenital syphilis in 2015, down from two in 2014.
“Women who are pregnant are being identified and treated, we can document that,” he said. “If you have a baby born with syphilis, that means you are having serious problems with your public health. This should not happen.”
He said the medical community wants to stop the spread of syphilis and get the word out about treatment options.
“We’re not here to judge, we are just trying to stop the transmission, and we need people to share (sexual) contact information to stop the chain of transmission,” MacLean said.
If the Fresno area wasn’t on the map when it was the site of a statewide conference on syphilis six months ago, it definitely is now.
Fresno County’s sexually transmitted disease investigators are overwhelmed, county officials say. They are buried under paperwork that has taken up much of their time. The county has hired clerical employees to handle the paperwork and allow investigators to spend more time in the field, Bird said.
The county also is preparing to hire two more “extra-help” investigators.
In the meantime, the state Department of Public Health has sent two health investigators to Fresno for an extended stay, and the CDC sent health investigators to Fresno earlier this month. Investigators are returning next week to seek solutions to Fresno County’s escalating syphilis rates.
Federal health officials were in Fresno to conduct an assessment earlier this month, said Joe Prado, division manager for community health in the county Department of Public Health.
“They were talking to state and county staff and looking at resources we have in place,” he said.
Even though these things are incredible challenges, all of this is preventable. This is a real winnable battle.
Heidi Bauer, sexually transmitted disease control branch chief, California Department of Public Health
Dr. Heidi Bauer, who spoke at the statewide syphilis-prevention meeting in Fresno, said the rising numbers in Fresno significantly exceed what is being seen statewide.
Syphilis was more prevalent among homosexual men than other groups until a few years ago, said Bauer, California’s branch chief for sexually transmitted diseases control.
“It’s a new phenomenon (statewide) that there is more heterosexual transmission over the last two or three years,” Bauer said.
In Los Angeles County, a number of its congenital syphilis cases were related to pregnant Chinese women coming to America to have children, she said. In China, Bauer said, syphilis cuts across all socioeconomic lines. She said stricter immigration enforcement apparently helped that county’s congenital syphilis cases decline from 31 in 2014 to 23 in 2015.
Now, other significantly affected groups are worrying state and local officials.
“There are challenges with access to care when it comes to homelessness and drug use,” she said. “Even though these things are incredible challenges, all of this is preventable. This is a real winnable battle.”
Digging for the source
In Fresno County, the syphilis problem is connected to drug users, specifically methamphetamine, and it’s not uncommon among the homeless. Both groups aren’t easily tracked and don’t seek help from doctors.
Jena Adams, a supervising communicable disease specialist for Fresno County, said about one-third of the congenital syphilis cases are women who regularly use methamphetamine.
Many of them aren’t getting prenatal care that could prevent the illness in babies. Others may get prenatal care but don’t return once they learn of their illness.
Dr. Mary McLain, who works at Clinica Sierra Vista medical clinics in downtown Fresno and west Fresno, said the clinics are increasing the number of syphilis screenings for pregnant patients to three, as recommended by the county: early in pregnancy, early in the third trimester and at birth.
All 10 of its Fresno County clinics have bicillin available for injections, she said.
McLain, who studied medicine in Washington, D.C., home to some of the highest sexually transmitted disease rates in the U.S., said there is far more syphilis in Fresno County.
“It seems like it’s still on the increase to me,” she said. “It’s a real public health threat.”
She said most people don’t realize they have the illness.
“Sometimes it’s just one sore and it doesn’t even hurt,” McLain said. “It’s important to be tested if you’re concerned at all.”
It’s also important, she said, for sexual partners to be tested.
In the last month, I’ve seen five or six people, who if they are not infected, they have been in the last year.
Dr. Mary McLain, Clinica Sierra Vista in Fresno
“In the last month, I’ve seen five or six people, who if they are not infected, they have been in the last year,” McLain said
And even if you’ve been successfully treated for syphilis, you can contract it again many times, she said.
Patients with syphilis can have drug problems, be involved in prostitution or have sexual addictions, McLain said.
Fresno County’s congenital syphilis problem also cuts along all ethnic lines, she said.
“This is a very contagious infection,” McLain said. “There are some stages of the disease where you can give it to people without sexual contact. When it goes untreated, the effects are silent, but horrible.”
The latest nationwide data from 2014 shows a 38 percent rise in syphilis, affecting all regions and ethnic groups, said Kidd, the CDC medical epidemiologist.
Fresno’s increases are much higher. As late as 2010, syphilis was nearly nonexistent in Fresno County with 10 to 20 cases. In 2015, about 150 cases were reported.
“We will be investigating to get at the source of why this is happening,” she said. “The root cause we’ve found varies a little bit from place to place.”
Kidd said the CDC is mobilizing multiple agency branches to assist Fresno County and will work with the county to develop a public messaging effort.
While Fresno County is hiring new investigators, which could take six months, federal and state investigators will fill the gap, Kidd said.
“The trends and numbers in Fresno are … definitely worrisome,” Kidd said.
To get help for syphilis or a sexually transmitted disease:
Fresno County: 559-600-3434
Kings County: 559-584-1401
Madera County: 559-675-7893
Tulare County: 559-623-0700 (Visalia), 559-685-5793 (Porterville)