Chen James L, Kodagoda Dulmini, Lawrence A Michael, Kerndt Peter R
California Epidemiologic Investigation Service, California Department of Health Services, Sacramento, USA.
Sex Transm Dis. 2002 May;29(5):277-84. doi: 10.1097/00007435-200205000-00005.
Despite national ambitions to eliminate syphilis, occasional outbreaks continue to occur in many areas of the United States.
The goal of the study was to describe and evaluate the public health interventions in response to an outbreak of syphilis in Los Angeles County among men who have sex with men.
Reported cases of primary, secondary, and early latent syphilis that occurred during an outbreak period from December 1999 to September 2000 were included in the study. The outbreak components of provider awareness, active surveillance, community-based organization recruitment, media campaign, community-outreach education and screening, and a correctional facility intervention were described. Screening results were reviewed, sexually transmitted disease (STD) hotline calls were counted, and a street-intercept survey was conducted.
A multifaceted outbreak response was initiated in March 2000. Of the 89 outbreak cases identified, 40% were detected by HIV/AIDS early intervention providers and 26% by private clinicians or health maintenance organizations. Other case identification sources included public STD clinics (10%), STD program case-management contacts (7%), mobile van screening (7%), and correctional facility screening (10%). Screening at high-risk venues detected a syphilis prevalence of <1% and an HIV prevalence of 6%. Weekly calls to the STD hotline increased 600% during the outbreak, and 80% of surveyed individuals cited the media as the source of their awareness of syphilis.
A multifaceted outbreak response was launched to react to an outbreak of syphilis among men who have sex with men. Prompt provider awareness and a preexisting network of HIV/AIDS providers aided case detection. Although the effectiveness of the response could not be scientifically determined, the diverse components of the response were associated with a faster decline in the outbreak than would have been expected. After 3 months, 89 cases had been identified. Outbreak preparedness should include a focus on communities of men who have sex with men, because the reintroduction of syphilis in this population may threaten national efforts toward syphilis elimination.
尽管美国有消除梅毒的国家目标，但在美国许多地区仍不时爆发梅毒疫情。
本研究的目的是描述和评估针对洛杉矶县男男性行为者梅毒疫情所采取的公共卫生干预措施。
本研究纳入了1999年12月至2000年9月疫情期间报告的一期、二期和早期潜伏梅毒病例。描述了疫情应对的各个组成部分，包括医疗机构意识、主动监测、社区组织招募、媒体宣传、社区外展教育与筛查以及惩教设施干预。审查了筛查结果，统计了性传播疾病（STD）热线电话，并进行了街头拦截调查。
2000年3月启动了多方面的疫情应对措施。在确定的89例疫情病例中，40%由艾滋病毒/艾滋病早期干预机构发现，26%由私人临床医生或健康维护组织发现。其他病例识别来源包括公共性病诊所（10%）、性病项目病例管理联系人（7%）、流动筛查车筛查（7%）和惩教设施筛查（10%）。在高危场所进行的筛查发现梅毒患病率<1%，艾滋病毒患病率为6%。疫情期间，STD热线每周的电话量增加了600%，80%的被调查者称媒体是他们了解梅毒的来源。
针对男男性行为者中的梅毒疫情启动了多方面的应对措施。医疗机构的及时意识以及现有的艾滋病毒/艾滋病医疗机构网络有助于病例发现。尽管无法科学确定应对措施的有效性，但应对措施的多样化组成部分与疫情比预期更快下降有关。3个月后，共确定了89例病例。疫情防范应包括关注男男性行为者群体，因为该人群中梅毒的再次出现可能威胁到国家消除梅毒的努力。
