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Volume: 26S6 - October 2000 1998/1999 Canadian Sexually Transmitted Diseases (STD) Surveillance Report Infectious Syphilis (Treponema pallidum)Syphilis is a disease that has been notifiable since the 1940s in Canada. Infectious (primary, secondary, and early latent) syphilis rates have declined steadily to the point of near elimination, and it is possible to label many regions in Canada as "syphilis-free", having had 3 or more years with no cases (Figure 12). An outbreak in British Columbia increased the Canadian rate in 1998 to 0.5 per 100,000 from 0.4 per 100,000 in 1996 (Figure 13). From 1993 to 1996, the highest incidence of infectious syphilis was predominantly found in the under-30 age group for both males and females (Figure 14). In 1997, the highest incidence was found in the older, 30-39 year, age group. Thus, we have seen the incidence of infectious syphilis shift from a younger (15-29) to an older (30-49) age group over the past 8 years. There were two reported cases of congenital syphilis in Canada in 1998 (Appendix 1.3C). FIGURE 12 Infectious Syphilis* in Canada - Average Annual Cases from 1997 to 1999**
* Infectious syphilis: primary and secondary and early latent. Source: Health Canada, Division of STD Prevention and Control, 2000 FIGURE 13 Reported Infectious Syphilis1 Rates2 in Canada, 1993 to 19993 1 Infectious syphilis: early symptomatic (primary & secondary)
+ early latent syphilis. Source: Health Canada, Bureau of HIV/AIDS, STD and TB, 2000 FIGURE 14 Reported Infectious Syphilis1 Rates2 in Canada by Age Group, 1993 to 19993
1 Infectious syphilis includes early symptomatic and early
latent syphilis. Source: Health Canada, Bureau of HIV/AIDS, STD and TB, 2000 Discussion The rise in infectious syphilis incidence since 1996 is predominantly due to the Vancouver outbreak, which is characterized by complex interactions between sex and drug use/trade in a geographically limited area. The endemic population of this area is generally of disadvantaged socio-economic status and often "hard to reach". There are extensive gaps in our knowledge of these groups and in our ability to provide health care to them. Targeted surveillance is extremely important in order to identify the gaps and needs in this marginalized population. More information will lead to better intervention opportunities for public health care workers. Very low incidence with sporadic outbreaks seems to be typical of syphilis epidemiology in Canada in the late 1990s. On a large-scale basis, syphilis has declined to a point very close to elimination. On a small-scale basis, low syphilis incidence rates are interrupted by outbreaks and ongoing regional epidemics. The identification of "syphilis-free" zones in Canada to denote areas that have had a minimum of three consecutive years with no new infectious syphilis cases is useful in geographically delineating these sporadic eruptions. The Division of STD Prevention and Control is actively working to intensify syphilis control in Canada. Current issues and strategies include enhanced surveillance of incident cases, rapid outbreak response, mapping of social and sexual syphilis networks, and identification of imported cases. At the Joint HIV/AIDS/STD Epidemiology and Surveillance Meeting in November 1999, the Division of STD Prevention and Control received strong support from provincial and territorial epidemiologists for additional resources to be committed to syphilis elimination. Although elimination of endemic syphilis in Canada is now our intended goal, in the meantime it is imperative that we remain vigilant in syphilis prevention and control while improving existing capacity to respond to outbreaks quickly.
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