Native American communities hit hardest in congenital syphilis surge: shots

Melissa Waiako oversees about two dozen public health nurses across the Navajo Nation who search for patients who have tested positive or been exposed to syphilis.

Navajo Regional Indian Medical Service

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Navajo Regional Indian Medical Service

Melissa Waiako oversees about two dozen public health nurses across the Navajo Nation who search for patients who have tested positive or been exposed to syphilis.

Navajo Regional Indian Medical Service

From her base in Gallup, New Mexico, Melissa Waiako criss-crosses the vast Navajo Nation, visiting patients who have tested positive for or been exposed to syphilis, a disease that was once nearly eradicated in the United States. She is supervising about 20 public health nurses who are looking for a job.

This region of the Southwest – a 27,000 square mile reservation that includes parts of Arizona, New Mexico and Utah – has some of the highest infection rates in the nation. And they're far worse than anything Waiako, a native of Zuni Pueblo (about 40 miles south of Gallup) and a nursing consultant for the Navajo Area Indian Health Service, has seen in her 30-year career as a nurse. Thing.

The number of people infected with syphilis nationwide has been increasing rapidly in recent years. In 2022, prices will reach a 70-year high, according to the latest data from the Centers for Disease Control and Prevention.The rise occurs during lack of penicillinis the most effective treatment.

At the same time, congenital syphilis (syphilis transmitted from pregnant people to their babies) is also occurring. similarly out of control. If untreated, congenital syphilis can cause bone deformities, severe anemia, jaundice, meningitis, and even death. In 2022, CDC recorded Of the 3,761 cases of congenital syphilis reported in the same year, there were 231 stillbirths and 51 infant deaths due to syphilis.

And while cases are rising across the United States, no demographic has been hit harder than Native Americans. According to CDC data released in January, Congenital syphilis rate By 2022, the rate of American Indian and Alaska Native babies will be three times that of African Americans and nearly 12 times the rate of white babies.

“This is a disease that not so long ago we thought we could eradicate, because there are treatments that really work,” said Megan Currie O'Connell, a member of the Cherokee Nation and chief public health officer for the City of the Great Plains. . Tribal Leadership Health Committee based in South Dakota.

Instead, Native American congenital syphilis infection rates (644.7 items The infection rate per 100,000 people in 2022 is now comparable to the infection rate for the entire U.S. population in 1941, before doctors started using penicillin to treat syphilis. 651.1 per 100,000. The national rate fell to 6.6 in 1983.

O'Connell said the Great Plains Tribal Leadership Health Council and tribal leaders in North Dakota, South Dakota, Nebraska and Iowa are citing that. asked Federal Health and Human Services Secretary Xavier Becerra plans to declare a public health emergency in each state.declaration will expand Staffing, funding, and access to contact tracing data across the region.

“Syphilis is deadly to infants. It is highly contagious and has very serious consequences,” O'Connell said. “We need to hire people to work in the field right now.”

Public health resources will be diverted to COVID-19 care

In 2022, New Mexico reported: Highest incidence of congenital syphilis between states. Primary and secondary syphilitic infections, which are not contagious to infants, are tallest in south dakotaIn 2022, the incidence of congenital syphilis was the second highest.

In 2021, the most recent year for which demographic data is available, South Dakota second worst rate Nationwide (District of Columbia and beyond) — and how many the best of all situation many indigenous peoples.

in October news release, the New Mexico State Department of Health said the state “reported a 660% increase in cases of congenital syphilis over the past five years.” The previous year, in 2017, there was just one case reported in New Mexico, but by 2020, that number had increased to 43, and by 2022, to 76.

These public health nurses from the Navajo Area Indian Health Service are able to test and treat patients for syphilis at home. The Navajo Nation has one of the highest rates of syphilis infection in the nation.

Navajo Regional Indian Health Service

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Navajo Regional Indian Health Service

These public health nurses from the Navajo Area Indian Health Service are able to test and treat patients for syphilis at home. The Navajo Nation has one of the highest rates of syphilis infection in the nation.

Navajo Regional Indian Health Service

Since 2020, the situation has worsened due to the coronavirus disease (COVID-19) pandemic. “Nearly 95% of the nation's public health has been directed to COVID-19 care,” said Jonathan Iral, chief clinical consultant for infectious diseases at the Indian Health Service, based at the Gallup Indian Medical Center. Stated. “This was a really hard-hit area.”

At one point early in the pandemic, the Navajo Nation reported: Highest new coronavirus infection rate In the United States, Iral suspects that patients with symptoms of syphilis are avoiding seeing doctors for fear of contracting the new coronavirus. Still, he doesn't think it's fair to blame the pandemic for the high rates of syphilis and the higher rates of infection among women. Pregnant baby, it continues even after 4 years.

Native Americans are more likely live in the countrysidefar from hospital obstetrics unit, more than any other race or ethnicity. As a result, many people do not receive prenatal care until late in pregnancy, if at all. This often means that health care providers are unable to test or treat patients for syphilis before birth.

In New Mexico, 23% of patients Not receiving prenatal care until after the fifth month of pregnancy or receiving less than half of the number of visits appropriate for the infant's gestational age in 2023 (national average is less than 16%).

distrust of health care providers;

Inadequate prenatal care is especially dangerous for Native Americans, who are more likely to transmit syphilis infections when pregnant than other ethnic groups. That's because in indigenous communities, syphilis infections are just as common among women as men. any other ethnic groupMen are at least twice as likely to contract syphilis, primarily because men who have sex with men are more likely to become infected.

Ms O'Connell said it was unclear why women in Indigenous communities were disproportionately affected by syphilis.

“The Navajo Nation is a maternal health desert,” says Amanda Singer, a Diné (Navajo) doula and lactation counselor in Arizona and executive director of the Navajo Breastfeeding Coalition/Dine Doula Collective. In some areas of the reservation, a patient must drive more than 100 miles to get to obstetric services. “So many pregnant women do not receive prenatal care throughout their pregnancy.”

She said this was due not only to a lack of services but also to mistrust of health care providers who did not understand Indigenous culture. Others worry that health care providers will report patients who use illegal drugs during pregnancy to police or child welfare.

But it's also because the network of facilities is shrinking. Two of the Navajo region's labor and delivery wards have closed in the past decade.according to recent reportsmore than half of rural hospitals in the United States do not offer delivery services.

Singer and other doulas in her network believe New Mexico and Arizona can combat the syphilis epidemic by expanding access to prenatal care in rural Native American communities. Singer envisions a system where midwives, doulas and lactation counselors could visit families and provide prenatal care “at home.”

Gallup Indian Medical Center is a hospital located in Gallup, New Mexico, near the Navajo Nation.

Cecilia Nowell appears on KFF Health News

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Cecilia Nowell appears on KFF Health News

Gallup Indian Medical Center is a hospital located in Gallup, New Mexico, near the Navajo Nation.

Cecilia Nowell appears on KFF Health News

O'Connell said data-sharing arrangements between tribes and state, federal and IHS offices vary widely across the country, but some Native communities, including hers, face additional challenges in tackling outbreaks. He added that it is causing Her Tribal Epidemiology Center fighting for access South Dakota data.

Iral said that in the Navajo Nation and surrounding areas, IHS infectious disease physicians meet monthly with tribal stakeholders to ensure that all pregnant women are exposed to the disease, and that state, tribal, and IHS He said he recommends holding regular meetings between providers and public health nurses. Testing and treatment is being done in those areas.

IHS currently recommends that all patients be tested for syphilis annually, and pregnant patients are tested three times. We have also expanded rapid and rapid testing and begun offering DoxyPEP, an antibiotic that transgender women and men who have sex with men can take within 72 hours after sex to reduce the transmission of syphilis. It has been proven. 87% increase. But perhaps the most important change IHS has made is the provision of on-site testing and treatment.

The public health nurses Waiako oversees are now able to test and treat patients for syphilis at home, something they couldn't do just three years ago when she was one of the public health nurses.

“Rather than dragging patients into penicillin, why not bring it to the patient?” Iral said.

Although this is not a tactic IHS uses for all patients, it has been effective in treating patients who may pass the infection on to their partners or babies.

Iral said the next few years will see the expansion of street medicine in urban areas and the proliferation of vans in rural areas, bringing more tests into communities and putting tests into the hands of patients through vending machines and the mail. I expect that it will be made available.

“This is a radical departure from our past,” he said. “But I think that’s the wave of the future.”

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of our core operating programs.KFF — An independent source for health policy research, polling, and journalism.