Hot Topics in Infection Prevention: Syphilis Surges, While J&J Vaccine on Pause

Syphilis Surge—Are We Neglecting Other Infectious Diseases?

During times of an outbreak and especially during a pandemic, all resources get thrown at responding to the issue. It’s natural though, to throw every resource—all but the kitchen sink—at an outbreak or emergent situation. The challenge then becomes, avoiding neglect of all the other health issues we’re facing. This isn’t the first time though, that we’ve seen other diseases surge as a result of all efforts focused on one and the impact to a health care and public health infrastructure. In response to the 2014-2016 Ebola virus outbreak in West Africa, there was a significant reduction in access to healthcare services that exacerbated malaria, HIV/AIDS, and tuberculosis.

Now, as we near a year and a half of COVID-19, we’re starting to see impacts to other infectious diseases. Syphilis is 1 that has been starting to rear its head. 2000 numbers left us with promise of near eradication, but since 2015, cases have risen by 74%. This trend though has been worrying public health officials more as congenital syphilis rates soared from 2012 to 2019.

In Fresno, congenital syphilis spiked 900% in 2018. Erica Pan, MD, MPH, noted that "It’s been a really long, hard year responding to this pandemic, but people have really acknowledged and realized the impact of divesting in public health infrastructure. I hope that a lot of the resources that we hope to bring to bear in the longer term after this pandemic will benefit STDs as well.” This serves as a critical reminder that in the midst of a pandemic, we need to be able to step back to see the full health care picture.

J&J Vaccine Pause Shouldn’t Instill Fear

This week was busy with the news of the single-dose Johnson & Johnson (J&J) vaccine and requested pause on distribution to investigate 6 blood clotting cases. Instantaneously, the news took off and began to instill fears about the safety of the vaccine. First, this recommended pause is an indicator of a vaccine safety system via the Food and Drug Administration(FDA) and the Centers for Disease Control and Prevention (CDC) is working. This surveillance and transparency are vital for vaccine safety and overall public trust in vaccination efforts. As virologist Angela Rasmussen, PhD, noted: “Approximately 1.5 million doses of the Johnson & Johnson vaccine have been administered to women under the age of 50, so if the risk is high only for that group, the incidence is around 1 in 250,000. Pregnancy, using hormonal contraceptives, and smoking all are associated with a much higher risk of this form of blood clotting than even crude estimates of the vaccine-related risk for clotting. The odds of having a blood clotting disorder as a result of having Covid-19 is much higher, affecting as many as 1 in 5 hospitalized patients. This means that if you received this vaccine and you are under 50, the odds are in your favor.”

The next Advisory Committee on Immunization Practices (ACIP) meeting to review data will be on Friday, April 23, which will be a likely deciding session for future recommendations and distribution. During this time though, it’s important to continue discuss vaccine safety, efficacy, and how the regulatory process is built around ensuring transparency and safety for individuals.