Salina Syphilis Outbreak Update

Saline County Health Department Director Jason Tiller told the county’s Health Advisory Council Tuesday that 16 cases of syphilis among Saline County residents have been “lab confirmed”. Although data continues to emerge, it appears that the demographic involved so far in the county’s syphilis cases are white males who are 40 years old or older.

Tiller said that the syphilis outbreak is occurring nationwide. It appeared first in Kansas in the KC metro area, the Wichita metro area, and in Geary County. While there were no cases of syphilis reported in Saline County during the first month of 2015, Saline County is now being impacted.

Jim Leckleiter, who is a registered nurse who is interested in infectious diseases, asked why the Health Department has not offer after-hours clinics and weekend clinics to provide education and perhaps testing services to those who have concerns. He characterized what the Health Department is doing presently as “nothing”. He said he has spoken at length with County Administrator Rita Deister. Lechleiter said the HD “gets a lot of money and has a responsibility to use grant money fully”.

Individuals can learn more about syphilis by going to the Center for Disease Control’s website, at www.cdc.gov and searching for the fact sheet on syphilis. Syphilis results from unprotected oral, anal or vaginal sex. It may or may not present with a rash.

Leckleiter said that individuals can also go to the website www.stdcheck.com. It uses a process to protect the sender’s identity but alerts potential contacts that it is “time to go in and be tested” because they may have been exposed to a sexually transmitted disease. (This writer was not able to verify this aspect of the website, but confirmed it does offer alternative testing and educational information.)

HAC member and physician specializing in infectious diseases, Jacob Hodges asked Tiller if Tiller had done any public service announcements yet, beyond the initial press release. Tiller responded he hadn’t scripted any additional announcements. When asked if pre-scripted announcements could be used, Tiller responded that he’d been searching websites www.kansashealthmatters.org and www.countyhealthrankings.org . Earlier in the meeting, Tiller said he’d traveled recently to Omaha and Washington DC. He has plans to travel to Hays to attend a two day workshop on teaching males on the role of fathering. Tiller said that “after the next couple of weeks, he planned to have conversations with the Kansas Department of Health and Environment’s experts in sexually transmitted diseases to see if more information about who is impacted by syphilis could be released so he could tailor the announcements to the population most impacted.

When asked if he accepted Tiller’s plan to possibly draft public service announcements in a couple of weeks, County Commission Chairman Monte Shadwick deflected the question. (The County Commission does not comment personnel issues publicly.) Asked the same question, Deister said Tiller had just been appointed HD Director and was wrapping up tasks he had performed as HD coordinator. She used the phrase “baby steps” to describe actions being taken now. The former Salina-Saline County Health Department operated for decades as a joint city and county entity and legally had its own autonomous Board of Health. But this changed when the roof of the HD “cracked”, the city pulled out of joint operations, and the administration of the HD was taken on by the county (as required by State statute). The County Commission serves as the Board of Health; the County did not have a HD Director from mid-October 2014 until November 2015, when Tiller was appointed to serve in that capacity.

HAC Vice Chair Gwenda Philbrook asked how the HD alerts medical providers that infectious diseases are being reported. Tiller said that the Kansas Health Alert Network sends messages to every facility but it is unclear how those get “pushed out” to individual health care providers. Tiller said there is also a local health alert network. It was unclear if this was used when the syphilis outbreak in Saline County was first reported or if it worked as intended. Tiller said that the HD is updating lists that HD Clinic Coordinator Joyce Schumacher has and is building new lists.

The HD learns of cases where infectious diseases are suspected or diagnosed from health care providers in two ways. Sometimes, the information comes directly to the HD. Other times, that information gets reported to KDHE and KDHE informs the county.

Leckliter raised concerns about how frequently the HD’s website is updated. Under the “news” tab, it only contains the original October 26 press release. Information on the HAC includes agendas and member contact information. Leckliter suggested that if the HD was having difficulty maintaining the website, the county should take it over. While the HD uses a text messaging service, it was not clear what triggers messages to be sent.

Tiller said the HD will “hand out condoms through a window” if asked. Leckliter said that having to ask for condoms might discourage some from asking.

Tiller said he had spoken to some high school classes. He’s had conversations with school nurses at USD 305; he’s learned the “human growth and sexuality” classes focuses on “blood borne pathogens” and does not address risky sexual behaviors. Participation in these classes is voluntary. Tiller said that one of those recently diagnosed with syphilis said “if we had been told about this in high school, I wouldn’t be in this situation now.”

Earlier, Deister provided County Commissioners with a copy of an article from The Atlantic. It can be viewed by going to www.theatlantic.com/health/archive/2015/12/the-return-of-syphilis/418170/.

Written by Naomi Sharp, dated December 3, 2015, “The Return of Syphilis” discusses the nationwide reemergence of this “once rare disease”. Tiller is quoted in the final paragraph of this article. “Tiller . . . believes yet another challenge is that physicians as well as patients aren’t used to considering syphilis as an option. He brings up a common saying in medical school: ‘when you hear hoofbeats, think horses, not zebras’—a reminder that the most likely diagnosis is often correct. If someone walks into a clinic with a rash, in other words, it’s probably something like poison ivy. Unless, as is increasingly the case, it’s secondary-state syphilis. Some times hoofbeats are zebras.”

Leckliter remains concerned that the HAC meets just once a month and the meeting ends in one hour, in spite of agenda topics that have not been discussed. He felt that the HAC “gave the impression that public comment isn’t welcome”.

Analysis

Tiller’s quote in The Atlantic implies that perhaps the Saline County medical community was a little slow in diagnosing and treating the on-gong syphilis outbreak. So, the public needs to educate themselves, practice safer sex, and seek medical care when appropriate. Saline County Health Department has staff who will answer questions and do the testing, if warranted, at no cost to the individual.

This was the third time the Health Advisory Council has met. Some members are familiarizing themselves with public health realities and some of the specifics around this outbreak. There was meaningful dialog as HAC members brought out concerns about what was going well and what areas needed more attention. This is a dramatic improvement from the second HAC meeting, where the syphilis outbreak was NOT discussed. The County Commission and public need the input of these advisors to help keep our community safe and well.

Other Items Discussed

Sherri LaFollette updated the HAC on the Baby and Me Tobacco Free grant. Compared to the state average where 13% of pregnant women smoke during their pregnancy, over 21% of Saline County pregnant women report smoking during their pregnancy. This results in a higher than average number of babies born who are premature and underweight.

Saline County obtained a grant though the March of Dimes that helps pregnant women and their partners quit smoking, if they were smoking during the pregnancy or three months prior. They attend classes that provide strategies to stop smoking. They also blow air into a monitor that measures the amount of carbon monoxide in their breath. As they make strides in reducing and quitting, the carbon monoxide levels drop. Then, with each monthly drop, the woman and her partner become eligible to receive a $25 voucher for diapers.

The Baby and Me, Tobacco Free grant has a success rate of about 60%. LaFollette said six moms have signed up to participate so far, but there is room for additional participants. LaFollette recently attended a workshop sponsored by the March of Dimes and Johnson & Johnson, which outlined strategies for reducing the number of elective births occurring before 39 weeks gestation.

Tiller said he recently attended a three day conference in Omaha for the Association of Health Care Emergency Preparedness Professionals. He also completed a leadership development two-day training in Washington D.C. with the National Association of City and County Officials. As a part of this, he met with Representative Tim Huelskamp and Senator Pat Robert’s aides to discuss health care concerns. Tiller plans to attend a two day training in Hays on “fatherhood” and hopes to incorporate it into the “Becoming a Mom” classes given at the HD.

Tiller briefly updated the group on initial conversations with Cindy Foley, Nutrition Director at USD 305 regarding childhood obesity concerns.

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story by Karen Shade for KSAL News