Policing/Incarceration
Syphilis on The Rise! Applied Epidemiology at The Federal Bureau of Prisons Enid Velez-Valle* Enid Velez-Valle Ellen Smith
Cases of syphilis and congenital syphilis are on the rise nationwide. Consistent with this pattern in the community, the Federal Bureau of Prisons has detected an increase in syphilis cases since 2018. Epidemiological analyses were performed to strategically implement efforts to decrease syphilis rates. Electronic medical records from 01/01/2018 to 12/31/2023 were used to identify and evaluate syphilis infections among Adults in Custody (AIC) in the federal prison system. Syphilis and comorbid health conditions were identified using ICD-10 codes. Laboratory information was included to identify average time-to-testing, and demographic and incarceration information from administrative records to assess subpopulations that may be at higher risk. Analyses included descriptive and regression analyzes using SAS Enterprise Guide (v8.3). The incidence of syphilis has reached an all-time high since 2018. There were 4 per 1000 AICs diagnosed with syphilis in calendar years 2022-2023. The average time-to-screening was 53 days. AICs diagnosed with syphilis were disproportionally female, AICs between 18-34 years old, White or Native American, Hispanic, residents of California, New York, or Florida, AICs primarily incarcerated for immigration crimes, and those who did not complete High School/GED. Females (OR=2.8, CI= 2.5, 3.1) and Native Americans (OR=1.9, CI=1.6, 2.3) had the highest odds of infection along with those with HIV (OR=19.5, CI=17.1, 22.2), Gonorrhea (OR= 9.2, CI=5.5, 15.5), and Chlamydia (OR=5.2, CI=3.7, 7.4). Prior to these analyses, many facilities were not conducting routine universal screening but instead risk-based screening, consistent with CDC recommendations at the time. These findings have helped push for universal screening, switching to a more sensitive reverse testing algorithm, an educational campaign for employees, and a new initiative to increase health education on sexual health that will be culturally competent for Native American subpopulations.