A syphilis outbreak among members of the Mille Lacs Band of Ojibwe has the Minnesota Department of Health seeking additional public health funding.
In a recent news release, MDH Commissioner Dr. Ed Ehlinger reported the outbreak was among three ongoing disease outbreaks in the state driving expenditures, including outbreaks of measles and drug-resistant tuberculosis.
"These outbreaks have already cost the state dearly in human and financial terms and will cause more problems if left unchecked," Ehlinger said in the release. "These funds will enhance the effectiveness of our response and help ensure that Minnesotans receive the high level of protection they expect and deserve."
The outbreak in Mille Lacs County is concentrated in the American Indian community and is related to drug abuse, MDH reported.
Syphilis cases in Minnesota increased by 30 percent between 2015-16. In 2016, 852 cases of syphilis were reported, with six cases of congenital syphilis. For 2017, 42 cases were associated with an outbreak in Mille Lacs County first identified in January. Of these, 22 cases are female and six are pregnant, and 14 of the 22 acknowledge drug abuse. In addition, MDH identified five cases in Red Lake County and four cases in Crow Wing County with links to the Mille Lacs outbreak.
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Syphilis can be treated with antibiotics. However, identifying and reaching people in contact with cases and ensuring those with syphilis are treated is very labor intensive, the release stated. Left untreated, syphilis can affect the nervous system and cause paralysis, sensory deficits, dementia and even death.
When pregnant women develop syphilis and are not treated, they can pass the infection onto their fetus. Congenital syphilis can result in miscarriage, stillbirth (40 percent), low birth weight or death shortly after birth. Babies born with congenital syphilis can have bone deformities, anemia, an enlarged liver and spleen, jaundice, blindness, deafness, meningitis and skin rashes. Moreover, babies with congenital syphilis may be developmentally delayed and have seizures.
At its peak, MDH had 22 staff responding to the syphilis outbreak linked to Mille Lacs County. Four outreach events occurred in Mille Lacs County in consultation with tribal leadership. The department's response to the broader syphilis outbreak requires continued outreach with tribal health, harm reduction and syringe services and coordination with drug treatment centers, the release stated.
In an emailed statement, Cassie Hill, director of nursing for the band, said tribal government officials were grateful for the partnership with MDH to increase community outreach.
"The Mille Lacs Band Health and Human Services team has been working aggressively to help educate community members and stop the spread of this disease," Hill stated. "We have an additional four health fair events coming up in October. To us, education is key: making sure community members are aware of the diseases, how they are spread and what treatment options are available. We have posted articles on our Health and Human Services Facebook page for facts about syphilis. We also have updated our Good Health TV program with providing information as well."
Harm reduction focuses on promoting scientifically proven ways of mitigating health risks associated with drug use and other high risk behaviors, including access to sterile syringes, condom distribution, medications for opioid dependence (such as methadone and buprenorphine) and overdose prevention.
"This is beyond our current resources," Ehlinger said in the release. "We expect the number of cases to increase due to the sometimes asymptomatic nature of syphilis combined with high drug usage and the transient nature of many outbreak-involved individuals. Additional resources will prevent further spread of this disease among high-risk populations and advance health equity."
Ehlinger estimated MDH would need $288,503 in resources for the syphilis outbreak in 2018. This includes $150,000 in grants to tribal governments for harm reduction and syringe services.
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Gov. Mark Dayton and state legislators together created a public health response account during the 2017 legislative session with the goal of strengthening the ability to respond to infectious disease outbreaks and other urgent public health threats.
The response to these outbreaks, including measles and drug-resistant tuberculosis, totaled nearly $1.5 million prior to July 1, including $534,000 for measles, $626,000 for multi-drug resistant tuberculosis and $336,000 for syphilis.
"We will not be requesting reimbursement for fiscal year 2017 expenses since they occurred prior to the law's enactment," Ehlinger said in the release. "However, we are seeking a total of $613,583 for response activities in fiscal year 2018."
In addition to the funding request to support the syphilis outbreak response, this includes:
• $100,445 to respond to the largest measles outbreak in the state in 30 years, concentrated in a large unvaccinated population within the Somali-Minnesotan community in Hennepin County.
• $224,635 to address a multi-drug resistant tuberculosis outbreak concentrated in older Hmong adults who attend senior centers in Ramsey County.
