Hepatitis: Finelli L

Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, Neitzel SM, Ward JW, Anonymous00115. · Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 1600 Clifton Road, MS G-37, Atlanta GA 30333, USA. · MMWR Recomm Rep. · Pubmed #18802412 links to  free full text

Abstract: Serologic testing for hepatitis B surface antigen (HBsAg) is the primary way to identify persons with chronic hepatitis B virus (HBV) infection. Testing has been recommended previously for pregnant women, infants born to HBsAg-positive mothers, household contacts and sex partners of HBV-infected persons, persons born in countries with HBsAg prevalence of >/=8%, persons who are the source of blood or body fluid exposures that might warrant postexposure prophylaxis (e.g., needlestick injury to a health-care worker or sexual assault), and persons infected with human immunodeficiency virus. This report updates and expands previous CDC guidelines for HBsAg testing and includes new recommendations for public health evaluation and management for chronically infected persons and their contacts. Routine testing for HBsAg now is recommended for additional populations with HBsAg prevalence of >/=2%: persons born in geographic regions with HBsAg prevalence of >/=2%, men who have sex with men, and injection-drug users. Implementation of these recommendations will require expertise and resources to integrate HBsAg screening in prevention and care settings serving populations recommended for HBsAg testing. This report is intended to serve as a resource for public health officials, organizations, and health-care professionals involved in the development, delivery, and evaluation of prevention and clinical services.

Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, Rodewald LE, Douglas JM, Janssen RS, Ward JW, Anonymous00214. · Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), Atlanta, GA 30333, USA. · MMWR Recomm Rep. · Pubmed #17159833 links to  free full text

Abstract: Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection. This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005;54[No. RR-16]:1-33). In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, health-care settings targeting services to IDUs, health-care settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, health-care providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, health-care providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination.

Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. · Epidemiology Branch, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. · Epidemiol Rev. · Pubmed #16754644 No free full text.

Abstract: Worldwide, two billion people have been infected with hepatitis B virus (HBV), 360 million have chronic infection, and 600,000 die each year from HBV-related liver disease or hepatocellular carcinoma. This comprehensive review of hepatitis B epidemiology and vaccines focuses on definitive and influential studies and highlights current trends, policies, and directions. HBV can be transmitted vertically, through sexual or household contact, or by unsafe injections, but chronic infections acquired during infancy or childhood account for a disproportionately large share of worldwide morbidity and mortality. Vaccination against HBV infection can be started at birth and provides long-term protection against infection in more than 90% of healthy people. In the 1990s, many industrialized countries and a few less-developed countries implemented universal hepatitis B immunization and experienced measurable reductions in HBV-related disease. For example, in Taiwan, the prevalence of chronic infection in children declined by more than 90%. Many resource-poor nations have recently initiated universal hepatitis B immunization programs with assistance from the Global Alliance for Vaccines and Immunization. Further progress towards the elimination of HBV transmission will require sustainable vaccination programs with improved vaccination coverage, practical methods of measuring the impact of vaccination programs, and targeted vaccination efforts for communities at high risk of infection.

Shepard CW, Finelli L, Fiore AE, Bell BP. · Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Pediatr Infect Dis J. · Pubmed #16148839 No free full text.

Abstract: Before the era of routine hepatitis B vaccination, an estimated 24,000 children acquired hepatitis B virus (HBV) infection each year in the United States. Childhood hepatitis B immunization has led to significant declines in the incidence and prevalence of HBV infection in U.S. children. Because the greatest burden of hepatitis B is caused by complications of hepatocellular carcinoma and cirrhosis in adults who were infected with HBV as children, most of the benefits of vaccination have yet to be realized. Reaching the goal of eliminating HBV transmission to children likely will require increasing vaccination coverage, ensuring timely administration of postexposure immunoprophylaxis to prevent more perinatal infections, and continued evaluation of the impact of immunization recommendations.

Shepard CW, Finelli L, Alter MJ. · Epidemiology Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. · Lancet Infect Dis. · Pubmed #16122679 No free full text.

Abstract: Hepatitis C virus (HCV) is a major cause of liver disease worldwide and a potential cause of substantial morbidity and mortality in the future. The complexity and uncertainty related to the geographic distribution of HCV infection and chronic hepatitis C, determination of its associated risk factors, and evaluation of cofactors that accelerate its progression, underscore the difficulties in global prevention and control of HCV. Because there is no vaccine and no post-exposure prophylaxis for HCV, the focus of primary prevention efforts should be safer blood supply in the developing world, safe injection practices in health care and other settings, and decreasing the number of people who initiate injection drug use.

Alter MJ, Kuhnert WL, Finelli L, Anonymous00051. · Division of Viral Hepatitis, National Center for Infectious Diseases, USA. · MMWR Recomm Rep. · Pubmed #12585742 links to  free full text

Abstract: Testing for the presence of antibody to hepatitis C virus (anti-HCV) is recommended for initially identifying persons with hepatitis C virus (HCV) infection (CDC. Recommendations for prevention and control of hepatitis C virus [HCV] infection and HCV-related chronic disease. MMWR 1998;47[No. RR-19] :1-33). Testing for anti-HCV should include use of an antibody screening assay, and for screening test-positive results, a more specific supplemental assay. Verifying the presence of anti-HCV minimizes unnecessary medical visits and psychological harm for persons who test falsely positive by screening assays and ensures that counseling, medical referral, and evaluation are targeted for patients serologically confirmed as having been infected with HCV. However, substantial variation in reflex supplemental testing practices exists among laboratories, and an anti-HCV-positive laboratory report does not uniformly represent a confirmed positive result. These guidelines expand recommendations for anti-HCV testing to include an option for reflex supplemental testing based on screening-test-positive signal-to-cut-off (s/co) ratios. Use of s/co ratios minimizes the amount of supplemental testing that needs to be performed while improving the reliability of reported test results. These guidelines were developed on the basis of available knowledge of CDC staff in consultation with representatives from the Food and Drug Administration and public health, hospital, and independent laboratories. Adoption of these guidelines by all public and private laboratories that perform in vitro diagnostic anti-HCV testing will improve the accuracy and utility of reported anti-HCV test results for counseling and medical evaluation of patients by health-care professionals and for surveillance by public health departments.

Vogt TM, Wise ME, Bell BP, Finelli L. · Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. · J Infect Dis. · Pubmed #18422440 No free full text.

Abstract: BACKGROUND: Since the mid-1990s, hepatitis A vaccine has been recommended for US children living in historically high-incidence states and for persons with other risk factors or chronic liver disease (CLD). The incidence of hepatitis A has declined dramatically during the era of vaccination, but trends in mortality are largely unknown. METHODS: US death certificates from 1990 to 2004 for which hepatitis A was listed as the underlying cause of death were analyzed. Average annual age-adjusted mortality rates during the prevaccine (1990-1995) and post-vaccination recommendation (2000-2004) periods were compared using a Mantel-Haenszel test of association. The number of deaths for which CLD was listed as a contributing cause was determined. RESULTS: Overall, 1436 deaths due to hepatitis A occurred, averaging 96 annually (range, 142 in 1995 to 54 in 2003). CLD contributed to nearly half of these deaths. Mortality rates paralleled incidence rates, beginning to decline in the mid-1990s and achieving low points in 2003 and 2004. Average rates were 32% lower in the post-vaccination recommendation period than in the prevaccine period (P < .01). The decline was more dramatic for states with (45%; P < .001) than without (23%; P = .002) recommendations. CONCLUSIONS: Hepatitis A mortality rates have declined over the past decade. CLD remains an important and preventable contributing cause of death due to hepatitis A.

Wise M, Bialek S, Finelli L, Bell BP, Sorvillo F. · Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA. · Hepatology. · Pubmed #18318441 No free full text.

Abstract: The disease burden and mortality from hepatitis C are predicted to increase in the United States as the number of persons with long-standing chronic infection grows. We analyzed hepatitis C mortality rates derived from US Census and multiple-cause-of-death data for 1995-2004. Deaths were considered hepatitis C-related if: (1) hepatitis C was the underlying cause of death, (2) chronic liver disease was the underlying cause and hepatitis C was a contributing cause, or (3) human immunodeficiency virus was the underlying cause and chronic liver disease and hepatitis C were contributing causes. A total of 56,409 hepatitis C-related deaths were identified. Mortality rates increased 123% during the study period (1.09 per 100,000 persons to 2.44 per 100,000), but average annual increases were smaller during 2000-2004 than 1995-1999. After peaking in 2002 (2.57 per 100,000), overall rates declined slightly, but continued to increase among persons aged 55-64 years. Overall increases were greater among males (144%) than females (81%) and among non-Hispanic blacks (170%) and Native Americans (241%) compared to non-Hispanic whites (124%) and Hispanics (84%). The 7,427 hepatitis C deaths in 2004 (mean age: 55 years), corresponded to 148,611 years of potential life lost. The highest mortality rates in 2004 were observed among males, persons aged 45-54 and 55-64 years, Hispanics, non-Hispanic blacks, and non-Hispanic Native American/Alaska Natives. Conclusion: Overall, hepatitis C mortality has increased substantially since 1995. Despite small declines in recent years, rates have continued to increase among persons aged 55-64 years. Hepatitis C is an important cause of premature mortality.

Simard EP, Miller JT, George PA, Wasley A, Alter MJ, Bell BP, Finelli L. · Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Infect Control Hosp Epidemiol. · Pubmed #17564979 No free full text.

Abstract: BACKGROUND: Hepatitis B virus (HBV) infection is a well recognized risk for healthcare workers (HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%. OBJECTIVE: To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels. DESIGN: Cross-sectional survey. METHODS: A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability-proportional-to-size methods during 2002-2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels. RESULTS: Among at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists (71.1%) and nurses' aides and/or other patient care staff (70.9%; P<.05). Hepatitis B vaccination coverage was highest among white HCWs (79.5%) and lowest among black HCWs (67.6%; P<.05). Compared with HCWs who worked in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material (76.6% vs 62.4%; P<.05). CONCLUSIONS: In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.

Wasley A, Miller JT, Finelli L, Anonymous00356. · Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed), 1600 Clifton Rd., N.E., MS G-37, Atlanta, GA 30333, USA. · MMWR Surveill Summ. · Pubmed #17363893 links to  free full text

Abstract: PROBLEM/CONDITION: In the United States, acute viral hepatitis most frequently is caused by infection with hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). These unrelated viruses are transmitted through different routes and have different epidemiologic profiles. Safe and effective vaccines have been available for hepatitis B since 1981 and, for hepatitis A, since 1995. REPORTING PERIOD: Cases in 2005, the most recent for which data are available, are compared with those from previous years. DESCRIPTION OF THE SYSTEM: Cases of acute viral hepatitis are reported to CDC via the National Notifiable Diseases Surveillance System. RESULTS: Since 1995, the incidence of reported acute hepatitis A has declined by 88%, to the lowest rate ever recorded (2005: 1.5/100,000 population). Declines were greater among children and in states where routine vaccination of children was recommended beginning in 1999, compared with the remaining states. The proportion of cases among adults has increased. Since 1990, reported acute hepatitis B incidence has declined by 79%, to the lowest rate ever recorded (2005: 1.8/100,000 population). Declines occurred among all age groups but were greatest among children aged <15 years. Since the late 1980s, acute hepatitis C incidence also has declined. In 2005, as in previous years, the majority of these cases occurred among adults, and injection-drug use was the most common risk factor. INTERPRETATION: The greater declines in hepatitis A rates among the states and age groups included in the 1999 recommendations for routine childhood hepatitis A vaccination suggest that this strategy reduced rates. Universal hepatitis B vaccination of children has resulted in substantially lower rates among younger age groups. Higher rates of hepatitis B continue among adults, particularly males aged 25-44 years, which emphasize the need to vaccinate adults at risk for HBV infection. The decline in hepatitis C incidence is primarily attributed to a decrease in incidence among injection-drug users (IDUs). The reasons for this decrease are multifactorial and are probably related to risk-reduction practices among IDUs. PUBLIC HEALTH ACTIONS: The recent expansion of recommendations for routine hepatitis A vaccination to include all children in the United States aged 12-23 months is expected to further reduce hepatitis A rates. Ongoing hepatitis B vaccination programs will ultimately eliminate domestic HBV transmission, and increased vaccination of adults who have risk factors will accelerate progress toward elimination. Prevention of hepatitis C relies on identifying and counseling uninfected persons at risk for hepatitis C (e.g., IDUs) regarding ways to protect themselves from infection.

Rein DB, Hicks KA, Wirth KE, Billah K, Finelli L, Fiore AE, Hoerger TJ, Bell BP, Armstrong GL. · RTI International, 2951 Flowers Rd, Suite 119, Atlanta, GA 30306, USA. · Pediatrics. · Pubmed #17200237 links to  free full text

Abstract: OBJECTIVES: Economic analysis is an important component in formulating national policy. We evaluated the economic impact of hepatitis A vaccination of all US children ages 12 to 23 months as compared with no vaccination and with current implementation of the preexisting (issued in 1999), regional policy. METHODS: We developed a Markov model of hepatitis A that followed a single cohort from birth in 2005 through death or age 95 years. From the societal perspective, the model compared the outcomes that resulted from routine vaccination at age 1 year to 2 scenarios: no hepatitis A vaccination and hepatitis A vaccination at levels observed in 2003 under the preexisting policy. We evaluated the economic impact of vaccination nationwide, in areas where vaccination was already recommended, and in areas where no previous recommendation existed. RESULTS: Without childhood vaccination, the approximately 4 million children in the 2005 birth cohort would be expected over their lifetimes to have 199,000 hepatitis A virus infections, including 74,000 cases of acute hepatitis A and 82 deaths, resulting in 134 million dollars in hepatitis A-related medical costs and productivity losses. Compared with no vaccination, routine vaccination at age 1 year would prevent 172,000 infections, at a cost of 28,000 dollars per quality-adjusted life year saved. Compared with maintaining the levels of hepatitis A vaccination under the preexisting regional policy, routine vaccination at age 1 year would prevent an additional 112,000 infections, at a cost of 45,000 dollars per quality-adjusted life year saved. CONCLUSIONS: The cost-effectiveness of nationwide hepatitis A vaccination compared with no vaccination, and the incremental cost-effectiveness of this recommendation compared with preexisting recommendations, is similar to that of other accepted public health interventions. In October 2005, the Advisory Committee on Immunization Practices recommended extending hepatitis A immunization to all US children ages 12 to 23 months.

Fleming DT, Zambrowski A, Fong F, Lombard A, Mercedes L, Miller C, Poujade J, Roome A, Sullivan A, Finelli L. · Mathematica Policy Research Inc., Princeton, NJ, USA. · Public Health Rep. · Pubmed #16416695 links to  free full text

Abstract: Although chronic hepatitis B and chronic hepatitis C are diseases of public health importance, only a few health departments nationally have chronic viral hepatitis under surveillance; these programs rely primarily on direct reporting by medical laboratories. We conducted an evaluation to determine if lessons from these programs can guide other health departments. Between December 2002 and February 2003, we visited the Connecticut Department of Public Health, the Multnomah County Health Department in Portland, Oregon, and the Minnesota Department of Health to determine the capacity of their chronic hepatitis registries to monitor trends and provide case management. We found that the registries facilitated investigations of potentially acute cases by identifying previously known infections, and aided prevention planning by pinpointing areas where viral hepatitis was being diagnosed. For chronic cases, case management (defined as the process of ensuring that infected individuals and their partners receive medical evaluation, counseling, vaccination, and referral to specialists for treatment when indicated) was provided for hepatitis B in Multnomah County, but was limited in other programs; barriers included resource constraints, difficulties confirming chronic infection, and privacy concerns. Finding innovative ways to overcome these barriers and improve case management is important if chronic hepatitis surveillance is to realize its full potential.

Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. · Epidemiology Branch, Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia 30333, USA. · Semin Dial. · Pubmed #15663766 No free full text.

Abstract: In December 2002, all U.S. chronic hemodialysis centers were surveyed regarding selected patient care practices and dialysis-associated diseases. The results were compared with similar surveys conducted in previous years. In 2002, 85% of hemodialysis centers were free-standing and 81% operated for profit; the proportion of centers operating for profit has increased each year since 1985. During 1995-2002, the percentage of patients who received dialysis through central catheters increased from 13% to 26%; this trend is worrisome, as infections and antimicrobial use are higher among patients receiving dialysis through catheters. However, during the same period, the percentage of patients receiving dialysis through fistulas increased from 22% to 33%. The percentage of centers reporting one or more patients infected or colonized with vancomycin-resistant enterococci (VRE) increased from 12% in 1995 to 30% in 2002. During 1997-2002, the percentage of patients vaccinated against hepatitis B virus (HBV) infection increased from 47% to 56% and the percentage of staff vaccinated increased from 87% to 90%. In 2002, routine testing for antibody to hepatitis C virus (anti-HCV) was performed on patients at 64% of centers; anti-HCV was found in 7.8% of patients. In 2001, the Centers for Disease Control (CDC) published Recommendations for Preventing Transmission of Infections among Chronic Hemodialysis Patients. Centers were surveyed regarding their awareness of the recommendations and about a variety of infection control practices. In general, the incidence of HBV and HCV was not substantially different for the infection control practices evaluated, including where staff obtain clean supplies for patient treatment, reuse of unused and unopened supplies, and practices for changing external transducer filters/protectors. However, in 2002, the incidence of HBV infection was higher among patients in centers where injectable medications were prepared on a medication cart or medication area located in the treatment area compared to a dedicated medication room. Also, those centers that used a disposable container versus a nondisposable container for priming the dialyzer had a significantly lower incidence of HCV.

Tokars JI, Finelli L, Alter MJ, Arduino MJ. · National Center for Infectious Diseases, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia 30333, USA. · Semin Dial. · Pubmed #15250925 No free full text.

Abstract: In December 2001, all U.S. chronic hemodialysis (HD) centers were surveyed regarding selected patient care practices and dialysis-associated diseases. The results were compared with similar surveys conducted in previous years. During 1997-2001, the percentage of patients vaccinated against hepatitis B virus (HBV) infection increased from 47% to 60% and the percentage of staff vaccinated increased from 87% to 89%. In 2001, an estimated 65% of patients had been vaccinated for influenza and 26% for pneumococcal pneumonia. In 2001, routine testing for antibody to hepatitis C virus (anti-HCV) was performed on staff at 42% of centers and on patients at 62% of centers; anti-HCV was found in 1.5% of staff and 8.6% of patients. In 2001, the incidence of HBV infection was higher among patients in centers where injectable medications were prepared at the dialysis station, and both HCV prevalence and incidence were higher among patients in centers where injectable medications were prepared at the dialysis station compared to a dedicated medication room. During 1995-2001, the percentage of patients who received dialysis through central catheters increased from 13% to 25%; this trend is worrisome, as infections and antimicrobial use are higher among patients receiving dialysis through catheters. However, during the same period, the percentage of patients receiving dialysis through fistulas increased from 22% to 30%. In 2001, 25% of catheters were used for new patients awaiting an arteriovenous (AV) access, 28% for established patients with a failed access awaiting new AV access, 40% as an access of last resort, and 6% for other reasons, including patient preference. The percentage of centers reporting one or more patients infected or colonized with vancomycin-resistant enterococcus (VRE) increased from 12% in 1995 to 31% in 2001.

Finelli L, Farley TP, Gibson JJ, Langley C, Hwang LY, Levine WC. · Epidemiology Branch, Division of Viral Hepatitis, National Center for Infectious Diseases, MS G-37, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA. · Sex Transm Dis. · Pubmed #12466718 No free full text.

Abstract: BACKGROUND: Syphilis seroprevalence data can be used as an independent measure of syphilis trends and to augment syphilis case report data for program planning. The prevalence of reactive syphilis serology in jails, delivery rooms, and drug treatment centers was examined from 1995 to 1999. Prevalence was evaluated by age and gender at each site and compared with county primary and secondary syphilis case rates. Annual prevalence of high titer-reactive serology in jails was compared with primary and secondary syphilis case rates. GOAL: The goal was to examine trends in syphilis seroprevalence and to evaluate the relationship of trends in seroprevalence to reported cases. STUDY DESIGN: This was a cross-sectional survey. RESULTS: Prevalence of reactive serology and high titer-reactive serology was lowest among women in delivery rooms (2.9% and 0.4%, respectively) and highest among women in jails (11.1% and 4.1%, respectively), indicating substantial recently treated or active infection among women in jails. Trends in high titer-reactive serology were similar to primary and secondary syphilis case rates. CONCLUSION: The prevalence of high titer-reactive serology can provide valuable information about community syphilis morbidity for use in prevention and control programs.