The preventable tragedies on Black babies

The tragic, preventable reasons

Robert McDonald, who focuses on STI prevention at the CDC, said, ‘People thought we had gotten rid of syphilis (SYP) when it in fact came back and is significantly increasing. To reverse the trends, public health authorities are trying to reach women at the highest risk for passing syphilis to their babies. People who are homeless, exchange sex for money, or use drugs are more likely to be exposed to STIs and less likely to seek prenatal care or STI testing.

On the rise, but public care is shifting away from condom promotion

In Portland, Ore., county workers paid for pregnant women without stable housing to stay in a hotel for three weeks. This ensures they receive the three-shot regimen needed to quash the bacterial infection.

In Los Angeles, the county jail began screening for female inmates. The health department is planning to hold events where women experiencing homelessness can receive screenings alongside clothes, showers and food.

“These things are all kind of converging and creating this social milieu in which we are seeing this preventable end up with tragic outcomes,” said Sonali Kulkarni, who leads the STI prevention division of the Los Angeles County Department of Public Health.

Health officials say the pandemic made it harder to respond to STIs. Dwindling staff and money were redeployed to COVID. Compared to the novel health threats that captivate public attention, such as the coronavirus, pox, and bird flu, syphilis can seem like old news.

Prevention

The first step to saving a baby from being born with the disease is checking whether the mother is infected. However, just a few states — namely Arizona, Texas, and North Carolina — require the most comprehensive syphilis testing, covering the first visit, third trimester, and delivery, according to a 2021 review of laws compiled by the CDC.

Furthermore, the CDC, in examining congenital syphilis (CS) cases from 2020 with medical histories available, found that 41 per cent had no timely prenatal care or testing. Nearly as many were diagnosed with it but did not receive adequate treatment.

Moreover, when a pregnant woman tests positive, the only recommended treatment to prevent a congenital case — Bicillin L-A — can be hard to come by. Pfizer is the sole manufacturer, and there’s no generic version available. Due to its expense, pharmacies and private health providers often don’t stock it, making initiating treatment difficult. Public health departments are the most likely to have the shots on hand.

Inside the Biden administration plan to address maternal mortality

In rare cases, patients who did receive timely testing and treatment still risk passing the STI to their babies.

In early March, a 32-year-old Houston mom held her newborn son with a full head of brown hair. Minutes later, doctors whisked him to the neonatal intensive care unit to begin treatment.

The mother, who spoke on the condition of anonymity to discuss her medical history, said she still tested positive at delivery. This is despite having already had two rounds of treatment during her pregnancy.

Doctors carried out a lumbar puncture, or spinal tap, on the boy to check for neurosyphilis. Neurosyphilis occurs in 60 per cent of babies with symptoms. After 10 days in the NICU, during which her son received penicillin through a tiny intravenous line, the woman was able to bring him home.

“You don’t want to lose somebody before you get to know him,” she said.

She must bring her son back to the hospital for follow-up visits every two months for a year. This is because syphilis and its effect on babies is very hard to detect, said her doctor, Irene A. Stafford, a maternal-fetal doctor at the University of Texas Health Science Center.

Stafford’s take on the subject

Stafford said she sees the consequences of resurgence in her patients every day. One in 555 babies in Texas is born with CYS, according to the Texas Health Department.

She] was haunted by a case with a teen mother whose relative was trafficked. The woman had received little to no prenatal care. She visited the emergency room complaining of symptoms during her pregnancy. She never underwent screening and birthed a baby with neurosyphilis. The baby is 5 years old and still can’t swallow solid food. The child requires speech and physical therapy and care in multiple pediatric specialities.

The teenager got pregnant again after not completing the treatment regimen and birthed a second child again infected. Today, she is homeless, and her mother cares for the children.

Studies show that about half of women with the disease don’t report risk factors. These include transactional sex, drug abuse, bad housing and sexual violence. They may fear losing custody of their children. As a result, they don’t get the robust screening that could lead to treatment for them and their babies.

Diagnosis can often be missed.

Most women do not know they have it because it doesn’t hurt, doesn’t burn, and doesn’t itch. Stafford, who has received a federal grant to develop a simpler syphilis home test for moms and newborns, often misses any symptoms that develop; even the most astute physician can miss them.

In Phoenix, there is an organisation that provides care for babies suffering from opioid withdrawal, Hushabye Nursery. Staffers at Hushabye Nursery said the recent rise in infants born with the disease is especially concerning. This is because the babies who need a quiet, dark environment to ease the pain of withdrawal must instead spend 10 days in loud, bright neonatal intensive care units to receive treatment. After pairing with health departments to increase screening, they prevented three potential cases. They did this by getting the mothers into treatment, said nursery co-founder Tara Sundem.

The University of Chicago Medical Center started screening emergency room patients in 2019. They brought testing and treatment to the place where high-risk women experiencing homelessness and addiction tend to seek medical care. This kind of universal screening at hospitals remains rare.

Public health workers are conducting more outreach in Multnomah County, Oregon, which includes Portland. Outreach in homeless encampments and shelters as they saw a rise in infections in people who reported using drugs. This is often while living on the streets. In one instance, a pregnant woman who lived in a tent under a bridge received her diagnosis and first penicillin shot at an emergency room but stopped coming back. A county nurse came to her tent to bring the next two shots.

State laws

Some experts associated the uptick in cases with varying state laws on screening. Eleven states, mostly in the Southeast, have yet to expand Medicaid. This is for all low-income adults, which would cover the costs of treatment. It leaves pregnant people with an increased chance of getting infected again if their partners remain without treatment.

Mark Turrentine, a professor of obstetrics and gynaecology at Baylor College of Medicine in Houston, said, “It’s frustrating because if we deploy timely interventions, we can turn this condition around.”

Several states, including Mississippi in March, have recently increased their screening requirements. This is in response to the rise of congenital syphilis.

However, the closure of rural hospitals and OB/GYN services has created big geographical gaps in accessing prenatal care. Thomas Dobbs, Mississippi’s former public health director, said, “If you are a working mom who maybe doesn’t get much sick time — or any sick time — and you have a 100-mile drive just to get to a prenatal care visit, that’s a huge impediment.”

Even if care were readily available, public health experts say many expectant Black mothers are reluctant. They don’t believe doctors have their best interests at heart. This is because of the medical establishment’s long history of improper treatment of Black patients.

Final message

Louisiana’s top health official, Joseph Kanter, has treated patients with a history of CS. This is a legacy of the infamous Tuskegee experiments. Researchers carried out experiments where they left hundreds of Black men untreated for the disease to study its long-term effects. It has created tragic irony. Kanter highlighted the significant presence of CYS among Black babies in Louisiana, linking it to a history of institutional racism. This failure to address syphilis in Black adults has fueled scepticism in their descendants towards a medical system capable of preventing the STI in Black infants.

He added, “We are dealing with many earned trust issues.”

Public health experts say the country has the strength to end CYS, often drawing parallels to the spread of HIV from mother to child. This reduced from 1,760 in 1991 to fewer than 40 in 2019. The plunge resulted from a national public health campaign with funding to adopt universal screening. It put doctors on alert and ensured that pregnant people with HIV received antiretroviral therapy and did not breastfeed their children.

Rebekah Horowitz, director of STI programs at the National Association of County and City Health Officials, stated, “The same focus has not been on CYS.”. “Without the focus and the funding, it won’t end.”