1 00:00:00,000 --> 00:00:13,480 Thanks for joining us at the Canadian Breakpoint, a Canadian infectious diseases podcast by 2 00:00:13,480 --> 00:00:16,480 Canadian infectious diseases physicians. 3 00:00:16,480 --> 00:00:22,120 I'm Summer Stewart, here with Dr. Rupeena Purewal, pediatric infectious diseases physician 4 00:00:22,120 --> 00:00:24,120 from Saskatoon. 5 00:00:24,120 --> 00:00:29,960 Today we're bringing you a highly requested topic, congenital syphilis, and we welcome 6 00:00:29,960 --> 00:00:36,280 Dr. Jared Bullard, provincial laboratory section head of pediatric infectious diseases in Winnipeg, 7 00:00:36,280 --> 00:00:41,880 as well as Dr. Karsten Kruger, antimicrobial stewardship fellow at CHEO. 8 00:00:41,880 --> 00:00:43,360 Dr. Purewal. 9 00:00:43,360 --> 00:00:45,800 All right, welcome everyone. 10 00:00:45,800 --> 00:00:51,280 Thank you so much for joining us for another episode of our podcast, the Canadian Breakpoint. 11 00:00:51,280 --> 00:00:57,120 Today we have two very special guests on our podcast, who will be talking a little bit 12 00:00:57,120 --> 00:01:03,200 about epidemiology and our project for congenital syphilis in Canada. 13 00:01:03,200 --> 00:01:07,520 So we have Dr. Jared Bullard and Dr. Karsten Kruger. 14 00:01:07,520 --> 00:01:12,560 Dr. Jared Bullard was born in Nassau, Bahamas, and moved to Winnipeg with his family when 15 00:01:12,560 --> 00:01:13,560 he was young. 16 00:01:13,560 --> 00:01:19,800 He is a product of Manitoba training, having completed his medical degree, including DSE 17 00:01:19,800 --> 00:01:26,440 in HIV immunology, pediatric and medical microbiology, and residencies and a fellowship in infectious 18 00:01:26,440 --> 00:01:29,520 diseases all through the University of Manitoba. 19 00:01:29,520 --> 00:01:35,200 He is currently the section head of pediatric infectious diseases and associate professor 20 00:01:35,200 --> 00:01:40,600 in the departments of pediatrics and child health and medical microbiology and infectious 21 00:01:40,600 --> 00:01:42,320 diseases. 22 00:01:42,320 --> 00:01:47,960 During the pandemic, Dr. Bullard helped define the methodology for studying the infectivity 23 00:01:47,960 --> 00:01:54,360 of SARS-CoV-2 and the clinical spectrum of COVID in Canadian children. 24 00:01:54,360 --> 00:01:59,480 He is currently working towards redefining the epidemiology diagnosis and management 25 00:01:59,480 --> 00:02:01,760 of congenital syphilis. 26 00:02:01,760 --> 00:02:08,000 His personal interests include his family, wife, Dr. Pamela Skrabeck, and future Dr. 27 00:02:08,000 --> 00:02:16,280 Bullard's daughter, Taya, and son Donovan, traveling and high level of sarcasm. 28 00:02:16,280 --> 00:02:18,160 And then we have Dr. Kruger. 29 00:02:18,160 --> 00:02:23,300 Dr. Karsten Kruger attended medical school at the University of Calgary, pediatrics residency 30 00:02:23,300 --> 00:02:28,360 at the University of Toronto, and an ID fellowship at the University of Ottawa. 31 00:02:28,360 --> 00:02:33,040 Currently he is completing an antimicrobial stewardship fellowship at CHEO and is co-principal 32 00:02:33,040 --> 00:02:39,880 investigator of the National Canadian Pediatric Surveillance Program, also known as CPSP study, 33 00:02:39,880 --> 00:02:41,840 on congenital syphilis. 34 00:02:41,840 --> 00:02:42,840 So welcome. 35 00:02:42,840 --> 00:02:43,840 Thank you. 36 00:02:43,840 --> 00:02:44,840 Happy to be here. 37 00:02:44,840 --> 00:02:46,560 Thanks for having us. 38 00:02:46,560 --> 00:02:47,560 Awesome. 39 00:02:47,560 --> 00:02:50,520 So today we're going to be talking about a very important topic. 40 00:02:50,520 --> 00:02:55,200 I think we've seen some media coverage around this. 41 00:02:55,200 --> 00:03:01,040 In our local hospitals, I think province-wide, where I'm in Saskatchewan, Dr. Bullard's in 42 00:03:01,040 --> 00:03:06,320 Manitoba, we're definitely seeing a rise in our numbers here as well. 43 00:03:06,320 --> 00:03:10,880 And so kind of without further ado, I think I'll hand it over to Dr. Bullard to let us 44 00:03:10,880 --> 00:03:13,000 know a little bit about the epidemiology. 45 00:03:13,000 --> 00:03:16,920 So our podcast is really geared towards all audiences. 46 00:03:16,920 --> 00:03:24,000 So we have nurses, pharmacists, physicians, trainees, and really across the world. 47 00:03:24,000 --> 00:03:29,360 So why don't we talk a little bit about the epidemiology in Canada in the last few years 48 00:03:29,360 --> 00:03:32,120 and specifically focusing on congenital syphilis. 49 00:03:32,120 --> 00:03:33,120 Yeah. 50 00:03:33,120 --> 00:03:40,240 When I think about this, and I've had a fall of seven years or so at this point to really 51 00:03:40,240 --> 00:03:47,640 dig into it, syphilis has been making a comeback in Canada in very specific populations. 52 00:03:47,640 --> 00:03:52,440 And so when we were first seeing it, and it's kind of across the country as well in larger 53 00:03:52,440 --> 00:03:56,600 urban centres, we were thinking primarily our GVMSN population. 54 00:03:56,600 --> 00:03:57,600 Right. 55 00:03:57,600 --> 00:04:01,320 And that was a variety of different reasons that was occurring. 56 00:04:01,320 --> 00:04:09,360 Part of it was in the early 2010s, more related to applications that were used for anonymous 57 00:04:09,360 --> 00:04:10,360 sex. 58 00:04:10,360 --> 00:04:12,400 And there was many challenges with that. 59 00:04:12,400 --> 00:04:16,640 And as a result, we started to see more and more cases of syphilis. 60 00:04:16,640 --> 00:04:21,680 As public health started to get a little bit more involved, trying to leverage how to use 61 00:04:21,680 --> 00:04:27,920 these applications and softwares, they managed to get kind of a hold on it to some degree 62 00:04:27,920 --> 00:04:30,080 in the GVMSN population. 63 00:04:30,080 --> 00:04:35,520 But simultaneously, we were starting to see increases in our heterosexual populations 64 00:04:35,520 --> 00:04:36,520 as well. 65 00:04:36,520 --> 00:04:37,520 Right. 66 00:04:37,520 --> 00:04:41,800 And we've seen that with other STIs as well. 67 00:04:41,800 --> 00:04:48,880 Gradually, what you saw was a migration of syphilis specifically into certain different 68 00:04:48,880 --> 00:04:49,880 populations. 69 00:04:49,880 --> 00:04:55,720 And so when we're talking about the Prairie provinces in particular, we were seeing it 70 00:04:55,720 --> 00:05:01,560 in our Indigenous First Nations populations, both urban, remote and northern communities. 71 00:05:01,560 --> 00:05:07,680 And a lot of that has to do with factories associated with being Indigenous, which I 72 00:05:07,680 --> 00:05:10,560 think Carson will talk about quite a bit more from our study. 73 00:05:10,560 --> 00:05:17,120 I think a lot of us are very familiar with the poverty and substance use and mental health 74 00:05:17,120 --> 00:05:21,200 and all the access to health care. 75 00:05:21,200 --> 00:05:26,640 And because you suddenly have it in the heterosexual population, you have it in women of reproductive 76 00:05:26,640 --> 00:05:28,600 age as well. 77 00:05:28,600 --> 00:05:33,040 And from that, it stems that if you aren't managing to find all of the women who have 78 00:05:33,040 --> 00:05:36,720 syphilis, we're not diagnosing it, we're not treating it. 79 00:05:36,720 --> 00:05:41,480 We'll see more higher syphilis clothing since that's where we started to see a lot more 80 00:05:41,480 --> 00:05:42,480 cases. 81 00:05:42,480 --> 00:05:49,640 Now, Alberta kind of gave us a little bit of an early hint to it in the 2000s, saying 82 00:05:49,640 --> 00:05:50,640 like, we have a problem. 83 00:05:50,640 --> 00:05:55,040 We have syphilis numbers in babies that were potentially higher than anywhere else in the 84 00:05:55,040 --> 00:05:56,040 country. 85 00:05:56,040 --> 00:05:57,040 It subsequently went away. 86 00:05:57,040 --> 00:06:02,040 But then now, seeing it again, primarily Prairie provinces, using these boxes for it. 87 00:06:02,040 --> 00:06:08,160 And then with the COVID pandemic, it really just kind of has not been able to be addressed 88 00:06:08,160 --> 00:06:10,160 as much as it possibly could. 89 00:06:10,160 --> 00:06:11,880 Yeah, no, that's fair. 90 00:06:11,880 --> 00:06:18,760 Yeah, I think most of our data, so I think Carson will bring this up as well. 91 00:06:18,760 --> 00:06:23,120 But just looking at the rates, I mean, definitely Alberta was leading and then Saskatchewan, 92 00:06:23,120 --> 00:06:26,760 Manitoba kind of trailing behind. 93 00:06:26,760 --> 00:06:33,880 And really, in terms of the last few years, we've really seen the spikes in congenital 94 00:06:33,880 --> 00:06:39,480 syphilis and really focusing on that childbearing age, women of childbearing age being infected. 95 00:06:39,480 --> 00:06:42,140 So when did... 96 00:06:42,140 --> 00:06:49,720 So in my experience, CPSP, which is the Canadian Pediatric Surveillance Program, usually targets 97 00:06:49,720 --> 00:06:53,860 rare infections when we're doing surveillance. 98 00:06:53,860 --> 00:07:03,360 So how did syphilis kind of make, I guess, its appearance in CPSP's reporting? 99 00:07:03,360 --> 00:07:05,880 How did that come about? 100 00:07:05,880 --> 00:07:13,960 Yeah, so the CPSP is a joint program of the Canadian Pediatric Society and Public Health 101 00:07:13,960 --> 00:07:19,400 Agency of Canada and aims to improve health of children by facilitating surveillance and 102 00:07:19,400 --> 00:07:27,440 research into any manner of childhood disorders that are high in disability, morbidity, or 103 00:07:27,440 --> 00:07:34,200 cost to society, despite their relative rarity. 104 00:07:34,200 --> 00:07:43,880 It came to the attention of the CPS Committee in the late 2010s when you really started 105 00:07:43,880 --> 00:07:50,560 to see an increase in nationally reported cases of congenital syphilis. 106 00:07:50,560 --> 00:07:59,880 And so myself, as a previous member of that committee, put together a team with Dr. Bullard 107 00:07:59,880 --> 00:08:06,840 to help surveil this and try to understand the Canadian landscape of how we could prevent 108 00:08:06,840 --> 00:08:11,680 it and how it was presenting and how it was being managed. 109 00:08:11,680 --> 00:08:13,920 Oh, that's really important. 110 00:08:13,920 --> 00:08:20,080 So I think definitely seeing the trends over time, looking at, I think a lot of us locally 111 00:08:20,080 --> 00:08:27,820 are also trying to see, and we're trying to see over the last few years, why is this happening? 112 00:08:27,820 --> 00:08:30,040 What population is this happening in? 113 00:08:30,040 --> 00:08:35,480 But it's nice that we have a central collaboration now with other centers and larger centers, 114 00:08:35,480 --> 00:08:40,520 which can also help out some of the smaller centers that are seeing this rise in numbers 115 00:08:40,520 --> 00:08:45,640 because obviously you need funding and support systems from a public health standpoint as 116 00:08:45,640 --> 00:08:46,640 well. 117 00:08:46,640 --> 00:08:47,640 Right? 118 00:08:47,640 --> 00:08:51,360 So we're very fortunate that we were able to do a project like this. 119 00:08:51,360 --> 00:08:58,960 I think, Kristen, you brought up kind of the main objectives of the project, but just for 120 00:08:58,960 --> 00:09:04,180 our listeners, just so they know kind of what was the clinical question or the hypothesis 121 00:09:04,180 --> 00:09:08,840 that we, or what are we trying to aim from this project? 122 00:09:08,840 --> 00:09:15,120 So as a surveillance study, we predominantly had objectives rather than hypotheses, but 123 00:09:15,120 --> 00:09:21,700 we aimed to describe the minimum incidence and distribution of cases nationally of confirmed 124 00:09:21,700 --> 00:09:25,440 and probable congenital syphilis cases. 125 00:09:25,440 --> 00:09:34,180 We also wanted to identify common risk factors of pregnant people who had an affected infant 126 00:09:34,180 --> 00:09:38,240 and the treatment they received during pregnancy. 127 00:09:38,240 --> 00:09:44,640 And then finally, we also wanted to describe the testing management and complications of 128 00:09:44,640 --> 00:09:47,840 infants with confirmed or probable congenital syphilis. 129 00:09:47,840 --> 00:09:48,840 Yeah. 130 00:09:48,840 --> 00:09:53,920 So really looking at it from many multiple angles, which is, I think, the way that we 131 00:09:53,920 --> 00:09:59,640 have to look at congenital syphilis and these rates because there's a lot of moving parts. 132 00:09:59,640 --> 00:10:05,560 There is, I think even in our study, you guys will probably talk about this as well. 133 00:10:05,560 --> 00:10:09,320 Just kind of looking at the risk factors and reinfection rates. 134 00:10:09,320 --> 00:10:11,720 I mean, there's so many layers to this, right? 135 00:10:11,720 --> 00:10:15,600 And that's kind of what we're seeing locally as well. 136 00:10:15,600 --> 00:10:24,480 So I know a lot of our audience is excited to hear what are the preliminary study findings 137 00:10:24,480 --> 00:10:26,040 and really what were the results. 138 00:10:26,040 --> 00:10:31,360 And I guess just for the audience to be aware, the study started back in our data is from 139 00:10:31,360 --> 00:10:36,360 January 2022, right, till December 31st. 140 00:10:36,360 --> 00:10:41,320 I think it was June 2021 was when the study started. 141 00:10:41,320 --> 00:10:42,320 Okay. 142 00:10:42,320 --> 00:10:43,320 Perfect. 143 00:10:43,320 --> 00:10:48,400 And so, and basically, and it's still ongoing, just so that our audience knows, and that's 144 00:10:48,400 --> 00:10:50,080 kind of why there's some preliminary results. 145 00:10:50,080 --> 00:10:57,040 So do you want to maybe give our audience some of the results and then we can all talk 146 00:10:57,040 --> 00:11:01,280 about and kind of elaborate on the areas of it as well? 147 00:11:01,280 --> 00:11:02,280 Sure. 148 00:11:02,280 --> 00:11:10,200 So to date, we've had 166 cases of confirmed or probable congenital syphilis reported through 149 00:11:10,200 --> 00:11:11,760 the study infrastructure. 150 00:11:11,760 --> 00:11:19,480 You know, the mean age of birthing parent was 27 years, but there was a wide range, 151 00:11:19,480 --> 00:11:22,480 17 to 39. 152 00:11:22,480 --> 00:11:31,480 You know, many of the individuals lived in an urban area, predominantly two thirds, and 153 00:11:31,480 --> 00:11:35,080 a third of them were from rural areas. 154 00:11:35,080 --> 00:11:41,800 The prairies were overrepresented, but sort of 79, 80% of all reported cases coming from 155 00:11:41,800 --> 00:11:42,800 there. 156 00:11:42,800 --> 00:11:52,120 The population groups of the pregnant people were largely unknown, 40% of them were unknown, 157 00:11:52,120 --> 00:11:59,040 45% were reported as having First Nations background, though this was all physician 158 00:11:59,040 --> 00:12:00,040 reported. 159 00:12:00,040 --> 00:12:01,040 Right. 160 00:12:01,040 --> 00:12:08,640 And then sort of moving into the risk factors, there was a large amount of unknown data, 161 00:12:08,640 --> 00:12:15,560 keep in mind that we're surveilling pediatricians who may not have access to the pregnant person's 162 00:12:15,560 --> 00:12:19,500 chart or these questions may not have been asked. 163 00:12:19,500 --> 00:12:25,640 But the most common risk factor we saw was substance use in pregnancy. 164 00:12:25,640 --> 00:12:35,000 So that was present in 66% of cases, and then was followed with, you know, previous child 165 00:12:35,000 --> 00:12:40,160 protection involvement sort of in about a third of cases. 166 00:12:40,160 --> 00:12:45,060 You know, but things like housing insecurity and social assistance, you know, those were 167 00:12:45,060 --> 00:12:49,360 less well known to pediatricians. 168 00:12:49,360 --> 00:12:54,880 You know, in terms of substances that were used, methamphetamines were the most common, 169 00:12:54,880 --> 00:13:03,120 sort of representing about half of the right substances. 170 00:13:03,120 --> 00:13:05,160 Okay. 171 00:13:05,160 --> 00:13:10,800 You know, it's important to note, though, that although this study, like reports on 172 00:13:10,800 --> 00:13:16,840 substance use as a risk factor, you know, substance use in the context of like structural 173 00:13:16,840 --> 00:13:23,960 risk factors like houselessness and income inadequacy, gendered and racial violence, 174 00:13:23,960 --> 00:13:30,320 these things are important and couldn't be well described in our data set. 175 00:13:30,320 --> 00:13:36,760 But you know, substance use we did find was associated with increased odds of inadequate 176 00:13:36,760 --> 00:13:43,640 prenatal care, lack of maternal treatment and a diagnosed sexually transmitted or blood 177 00:13:43,640 --> 00:13:50,240 porn co infection with significant P values. 178 00:13:50,240 --> 00:13:51,240 Okay. 179 00:13:51,240 --> 00:13:57,840 Yeah, so some of the data I mean, that you're presenting definitely is kind of consistent 180 00:13:57,840 --> 00:14:01,840 with more like resources that are available. 181 00:14:01,840 --> 00:14:10,440 You know, housing, for instance, and just kind of commenting on the factors about most 182 00:14:10,440 --> 00:14:14,520 of the cases were reported from urban centers. 183 00:14:14,520 --> 00:14:21,360 This was in your guys's study, based off of where the testing was done or where the treatment 184 00:14:21,360 --> 00:14:23,080 was obtained. 185 00:14:23,080 --> 00:14:27,760 This was based on the patient's postal code, actually. 186 00:14:27,760 --> 00:14:28,760 Okay. 187 00:14:28,760 --> 00:14:29,760 Yeah. 188 00:14:29,760 --> 00:14:34,400 And yeah, I know like in Saskatchewan locally, there are a lot of although people may be 189 00:14:34,400 --> 00:14:44,400 living in a remote community, their addresses could be, you know, listed in more urban center 190 00:14:44,400 --> 00:14:47,160 for multiple reasons and also migration, right? 191 00:14:47,160 --> 00:14:50,320 So people are moving around and that type of thing. 192 00:14:50,320 --> 00:14:55,300 But so that was something that kind of stuck out to me about your guys's preliminary studies 193 00:14:55,300 --> 00:14:57,620 as well. 194 00:14:57,620 --> 00:15:03,080 But I think a couple of the factors that you're mentioning here all kind of go down to things 195 00:15:03,080 --> 00:15:06,800 that, you know, public health has been watching is really in the part of the public health 196 00:15:06,800 --> 00:15:11,800 sector, resources, prenatal care. 197 00:15:11,800 --> 00:15:14,320 Is it access to care? 198 00:15:14,320 --> 00:15:21,920 You know, that's always a question whenever we think about these rates increasing. 199 00:15:21,920 --> 00:15:25,840 Is it lack of awareness in certain communities? 200 00:15:25,840 --> 00:15:29,080 So I don't know if Dr. Buller, do you want to maybe touch on some of that? 201 00:15:29,080 --> 00:15:35,600 Because I'm sure Manitoba and Saskatchewan are probably seeing a similar trend in terms 202 00:15:35,600 --> 00:15:36,600 of why this is happening. 203 00:15:36,600 --> 00:15:37,600 You're right. 204 00:15:37,600 --> 00:15:43,120 I mean, Saskatchewan and Manitoba have a number of parallels that we can draw on. 205 00:15:43,120 --> 00:15:47,080 When I look at what's been going on with congenital tippus, there's two things that you mentioned 206 00:15:47,080 --> 00:15:52,160 already, the preventative strategies that we can employ and the appropriate endorsing 207 00:15:52,160 --> 00:15:53,160 of those strategies. 208 00:15:53,160 --> 00:15:58,280 And I think that's one of the main things that this study is hoping to inform. 209 00:15:58,280 --> 00:16:04,000 Because we were looking at the case definitions, which is something that public health uses 210 00:16:04,000 --> 00:16:10,720 to say this is the number of kids that were high risk enough that they weren't in treatment. 211 00:16:10,720 --> 00:16:14,440 But we've written that down into probable and confirmed, which we still do. 212 00:16:14,440 --> 00:16:20,360 Now, if you're to look at who ultimately becomes confirmed, that's a small portion of the high 213 00:16:20,360 --> 00:16:23,360 risk exposed infants, when we consider probable. 214 00:16:23,360 --> 00:16:24,360 Right. 215 00:16:24,360 --> 00:16:29,200 And if we eliminate that, we've got maybe a third half of the number. 216 00:16:29,200 --> 00:16:33,480 And so the scope of the problem seems to be less than it actually is. 217 00:16:33,480 --> 00:16:38,760 When in reality, you know, you're spending about 15 to $20,000 per high risk, sickly 218 00:16:38,760 --> 00:16:44,240 controlled child for quality treatment and investigation in the hospital. 219 00:16:44,240 --> 00:16:45,240 And so that's the first step. 220 00:16:45,240 --> 00:16:49,120 You really have to think this is the scope of the problem, what's going on. 221 00:16:49,120 --> 00:16:52,360 And the next point would be to get appropriately a resource for that. 222 00:16:52,360 --> 00:16:55,320 Now, prevention in public health is huge. 223 00:16:55,320 --> 00:16:57,320 That's what their focus is. 224 00:16:57,320 --> 00:16:58,320 Right. 225 00:16:58,320 --> 00:17:00,080 And so there's a variety of ways we can do that. 226 00:17:00,080 --> 00:17:06,480 A lot of it is kind of testing, tracing, and that works okay. 227 00:17:06,480 --> 00:17:10,920 And it works fairly well when we're talking about our GBMSM populations. 228 00:17:10,920 --> 00:17:17,360 But as you kind of alluded to, then, our sublutena is very similar to Gatch when we have our 229 00:17:17,360 --> 00:17:22,120 indigenous population, which has a lot of migration, to be the right word, but they 230 00:17:22,120 --> 00:17:26,040 go from the city up north to the reserve and back. 231 00:17:26,040 --> 00:17:30,280 And it's not really clear where they always are or what their primary residence is. 232 00:17:30,280 --> 00:17:31,280 Yeah. 233 00:17:31,280 --> 00:17:34,920 So that makes it hard to do that contact tracing. 234 00:17:34,920 --> 00:17:39,080 So I think novel strategies kind of have to be employed as well. 235 00:17:39,080 --> 00:17:41,800 But I'm sure there's other things too to say. 236 00:17:41,800 --> 00:17:44,800 I can keep going through. 237 00:17:44,800 --> 00:17:48,600 But I think that, yeah, that's part of what we were looking at too is to say this is, 238 00:17:48,600 --> 00:17:50,880 you know, the actual scope of the problem. 239 00:17:50,880 --> 00:17:55,480 These are the preventative strategies that we think have been used in different provinces. 240 00:17:55,480 --> 00:17:58,480 How effective have they been? 241 00:17:58,480 --> 00:18:04,160 Novel strategies that we can employ because the testing, tracing, and tracing is good, 242 00:18:04,160 --> 00:18:06,600 but it's not seemingly enough at this point. 243 00:18:06,600 --> 00:18:11,920 Yeah, like it's not capturing, I think, the population entirely. 244 00:18:11,920 --> 00:18:18,640 And that's, I think, where we're still getting some of these missed cases where, you know, 245 00:18:18,640 --> 00:18:25,040 where they'll have no prenatal care and no access to the care, but then also we'll have 246 00:18:25,040 --> 00:18:26,200 reinfection rates, right? 247 00:18:26,200 --> 00:18:30,680 So that goes back to contact tracing and treating, testing. 248 00:18:30,680 --> 00:18:38,040 A lot of our centers, we don't have, you know, labs that are testing in all centers. 249 00:18:38,040 --> 00:18:43,520 So some of the samples in our northern communities are going, you know, traveling, the samples 250 00:18:43,520 --> 00:18:50,160 traveling a few hours before we can actually get testing and the turnaround time for testing 251 00:18:50,160 --> 00:18:51,160 is long. 252 00:18:51,160 --> 00:18:57,200 And I know I actually, in my first season, had Dr. Amita Singh come on, who is one of 253 00:18:57,200 --> 00:19:02,440 our STI specialists out in Alberta. 254 00:19:02,440 --> 00:19:05,440 And she talked a lot about her study with the point of care tests. 255 00:19:05,440 --> 00:19:09,320 And I know we've, you know, done a pilot project, implemented some of these measures. 256 00:19:09,320 --> 00:19:16,240 But again, does it really focus on testing and treating when you can't capture some of 257 00:19:16,240 --> 00:19:18,200 this population? 258 00:19:18,200 --> 00:19:19,200 So again, it's multifactorial. 259 00:19:19,200 --> 00:19:23,080 And I think we've kind of brought that up. 260 00:19:23,080 --> 00:19:29,480 But really for this study, kind of the aim, I think this is probably one of the first 261 00:19:29,480 --> 00:19:36,360 studies that I've seen in Canada, across Canada, that's looked at numbers and really looked 262 00:19:36,360 --> 00:19:42,680 at some of these risk factors that we're identifying, because I think that's where some of the hurdle 263 00:19:42,680 --> 00:19:49,420 was is that we don't have a national, prior to this, to my knowledge, and you guys can 264 00:19:49,420 --> 00:19:55,720 correct me if I'm wrong, we didn't really have a national database for these cases that 265 00:19:55,720 --> 00:19:56,720 we were seeing. 266 00:19:56,720 --> 00:20:05,120 And I think it was more so local public health departments that are really putting this data 267 00:20:05,120 --> 00:20:08,960 into their databases, analyzing it at the local standpoint. 268 00:20:08,960 --> 00:20:14,080 But really, I think it's a larger, it's a national problem. 269 00:20:14,080 --> 00:20:15,200 And should be. 270 00:20:15,200 --> 00:20:20,680 And so I'm excited that we finally have something where we can report these cases, because I 271 00:20:20,680 --> 00:20:22,800 think it's important to look at the trends, right? 272 00:20:22,800 --> 00:20:28,600 So trends that we're seeing, not just in one community, but overall. 273 00:20:28,600 --> 00:20:29,600 And is that correct? 274 00:20:29,600 --> 00:20:34,680 Is this the first kind of large study that we've done in congenital self-lessing Canada? 275 00:20:34,680 --> 00:20:37,400 Yeah, I would say so. 276 00:20:37,400 --> 00:20:39,800 Yeah, you hit the nail right on the head. 277 00:20:39,800 --> 00:20:47,920 This study generated a lot of public health interest, just given the paucity of case-level 278 00:20:47,920 --> 00:20:48,920 data. 279 00:20:48,920 --> 00:20:54,400 The national reporting is one thing, but it doesn't have the amount of detail that our 280 00:20:54,400 --> 00:20:55,400 study has. 281 00:20:55,400 --> 00:20:56,400 Yeah. 282 00:20:56,400 --> 00:21:01,640 And I think, Jared, you brought up another really good important point, which is the 283 00:21:01,640 --> 00:21:03,680 costs that we are seeing. 284 00:21:03,680 --> 00:21:10,360 So costs of treating, testing, treating these infants, even if they fall into the probable 285 00:21:10,360 --> 00:21:11,360 case. 286 00:21:11,360 --> 00:21:15,320 I mean, first step is really, I think the case definitions, and I agree with you, that's 287 00:21:15,320 --> 00:21:17,560 where my challenges were here. 288 00:21:17,560 --> 00:21:24,200 Really working with public health, like here, closely working with public health, but having 289 00:21:24,200 --> 00:21:29,800 kind of different impressions of really what is a confirmed case versus a probable case. 290 00:21:29,800 --> 00:21:34,680 And I think that's so challenging when you're looking at it from a research standpoint and 291 00:21:34,680 --> 00:21:37,920 when you're looking at it from a clinical standpoint, right? 292 00:21:37,920 --> 00:21:45,760 Because some of the data doesn't really overlap and it's challenging from that standpoint. 293 00:21:45,760 --> 00:21:50,240 But then when we look at how many cases, so I think there is some under-reporting for 294 00:21:50,240 --> 00:21:57,160 sure and really minimizing the problem when it is actually larger scale, especially when 295 00:21:57,160 --> 00:22:00,200 you're looking at it from a clinical lens. 296 00:22:00,200 --> 00:22:07,440 And so I think with having a study like this, where we do have a case definition, where 297 00:22:07,440 --> 00:22:13,320 even though it's voluntary reporting, so there are some challenges with that, but I think 298 00:22:13,320 --> 00:22:21,120 having something that's more centralized and almost a unified case definition for all of 299 00:22:21,120 --> 00:22:25,840 us to report these cases, I think is already the first step and the objective for me for 300 00:22:25,840 --> 00:22:28,000 this study. 301 00:22:28,000 --> 00:22:34,720 It was fantastic to see that we could actually all use same case definition and submit these 302 00:22:34,720 --> 00:22:39,320 cases because we know from a clinical standpoint, we're definitely seeing more congenital syphilis 303 00:22:39,320 --> 00:22:42,800 than what the numbers are showing. 304 00:22:42,800 --> 00:22:50,080 So looking point for sure is like here in Manitoba, we have our clinical database of 305 00:22:50,080 --> 00:22:55,760 all the congenital syphilis cases and then public health has their data for all the cases. 306 00:22:55,760 --> 00:22:57,960 And the lab has their database. 307 00:22:57,960 --> 00:23:02,520 When we line them all up, you're like, wow, they're quite different. 308 00:23:02,520 --> 00:23:04,520 Why are they so different? 309 00:23:04,520 --> 00:23:10,000 And that case definition is huge because we have a national case definition and then we 310 00:23:10,000 --> 00:23:12,680 have all the provincial ones too. 311 00:23:12,680 --> 00:23:19,200 And so that's actually something that I've been working on is to realign the case definition. 312 00:23:19,200 --> 00:23:24,160 And it is in fact informed and based on the work that Carson and I and our co-investigators 313 00:23:24,160 --> 00:23:28,840 did that we're trying to make it so that everybody's saying the same thing. 314 00:23:28,840 --> 00:23:29,840 Right. 315 00:23:29,840 --> 00:23:31,840 Yeah, that's huge. 316 00:23:31,840 --> 00:23:37,280 Sorry, Carson, I think I cut you off when you were talking about some of the preliminary 317 00:23:37,280 --> 00:23:38,840 findings there. 318 00:23:38,840 --> 00:23:42,360 Was there anything, I think you had wanted to touch probably a little bit about some 319 00:23:42,360 --> 00:23:47,240 of the treatment and the outcomes and the congenital syphilis cases as well. 320 00:23:47,240 --> 00:23:48,800 Oh yeah. 321 00:23:48,800 --> 00:23:55,920 And just kind of touching on what you had mentioned before, in terms of pregnant people 322 00:23:55,920 --> 00:24:01,800 coming with no prenatal care, about a quarter of our cases we saw that in and only about 323 00:24:01,800 --> 00:24:08,200 another quarter had at least one prenatal visit per trimester. 324 00:24:08,200 --> 00:24:13,460 So a significant portion of people had no screening in pregnancy. 325 00:24:13,460 --> 00:24:22,520 And then of those who did screen positive, about 20% actually didn't end up getting treated 326 00:24:22,520 --> 00:24:26,080 for one reason or another. 327 00:24:26,080 --> 00:24:33,040 We did see that chlamydia and gonorrhea co-infection were fairly common. 328 00:24:33,040 --> 00:24:39,160 And then in terms of the babies, recognizing that we don't know what we don't know in 329 00:24:39,160 --> 00:24:45,920 terms of missed cases, but of those that were reported to us, most of them were diagnosed 330 00:24:45,920 --> 00:24:48,880 within the first month of birth, 97%. 331 00:24:48,880 --> 00:24:54,840 And then about 90% of them had a treatment initiated within the first week of life. 332 00:24:54,840 --> 00:25:02,960 But as you've probably seen, many, over half of our babies had no exam findings of congenital 333 00:25:02,960 --> 00:25:04,500 syphilis. 334 00:25:04,500 --> 00:25:12,760 And so likely would have fallen into that probable category rather than confirmed and 335 00:25:12,760 --> 00:25:16,480 flown under the radar of the national case definition. 336 00:25:16,480 --> 00:25:17,480 Right. 337 00:25:17,480 --> 00:25:18,480 Yeah. 338 00:25:18,480 --> 00:25:23,680 And I think this is always challenging about congenital infections is there's... because 339 00:25:23,680 --> 00:25:30,600 asymptomatic is our most common presentation of most congenital infections. 340 00:25:30,600 --> 00:25:34,120 And so I don't know, this is a challenge I face clinically too, right? 341 00:25:34,120 --> 00:25:40,680 So you're trying to explain to even parents who did get treatment, but then let's say 342 00:25:40,680 --> 00:25:46,720 got reinfected or did not have an adequate response to treatment and trying to tell them 343 00:25:46,720 --> 00:25:52,880 that we still have to treat their infant, although they don't have any clinical findings. 344 00:25:52,880 --> 00:25:55,520 And so I think this is always something that's challenging. 345 00:25:55,520 --> 00:26:02,080 It's brought up by maternal services, it's brought up by NICU doctors. 346 00:26:02,080 --> 00:26:08,400 It's challenging, but I do want... and I haven't done a full congenital syphilis episode because 347 00:26:08,400 --> 00:26:14,000 I'm waiting for our new CPS statement to be released. 348 00:26:14,000 --> 00:26:20,760 And so we'll have Dr. Fennell actually come on an episode as well and talk a lot about 349 00:26:20,760 --> 00:26:23,940 more of the clinical characteristics and et cetera. 350 00:26:23,940 --> 00:26:28,160 So I won't go into that because really this is today's... although I have lots to say 351 00:26:28,160 --> 00:26:34,920 about all of that, but I think today we'll focus a little bit more on the study itself. 352 00:26:34,920 --> 00:26:42,640 So is there something else that you wanted to touch on, Karsten, in terms of the preliminary 353 00:26:42,640 --> 00:26:44,720 findings before we kind of talk about... 354 00:26:44,720 --> 00:26:47,680 So what is all this data going to help us do? 355 00:26:47,680 --> 00:26:49,240 I want answers, right? 356 00:26:49,240 --> 00:26:51,440 Because I'm like part of the... 357 00:26:51,440 --> 00:26:58,280 I'm the group that's like crying for help and I need, I guess, another angle to look 358 00:26:58,280 --> 00:26:59,280 at it. 359 00:26:59,280 --> 00:27:06,520 I don't think what we're currently doing is covering everything and that's challenging. 360 00:27:06,520 --> 00:27:08,560 Yeah. 361 00:27:08,560 --> 00:27:16,520 I think that the study is a good starting place in terms of describing some of the social 362 00:27:16,520 --> 00:27:21,840 factors that could be driving syphilis recurrence sort of across Canada. 363 00:27:21,840 --> 00:27:28,760 I think what this study has shown from a high level is that it's hard for us to sort of 364 00:27:28,760 --> 00:27:35,040 identify the specific drivers of syphilis in specific geographic locales within Canada. 365 00:27:35,040 --> 00:27:42,000 Jared had said it best before, I think that we don't just have one syphilis epidemic in 366 00:27:42,000 --> 00:27:45,240 Canada, we have several. 367 00:27:45,240 --> 00:27:50,040 And the drivers of syphilis are different within each community. 368 00:27:50,040 --> 00:27:59,240 And so I think what we will need to do is look at sort of at a more granular level, 369 00:27:59,240 --> 00:28:01,060 what are the barriers to prenatal care? 370 00:28:01,060 --> 00:28:06,080 What are the predisposing factors to reinfection and pregnancy? 371 00:28:06,080 --> 00:28:14,560 And try to work with public health and patients in their communities to develop these bespoke 372 00:28:14,560 --> 00:28:21,240 prevention strategies that are so desperately needed rather than a one size fits all solution. 373 00:28:21,240 --> 00:28:26,720 But the association that we were able to detect even with our large amount of missing data 374 00:28:26,720 --> 00:28:33,200 of substance use should prompt public health, I think, to continue working to ameliorate 375 00:28:33,200 --> 00:28:37,520 the social circumstances that predispose to that use. 376 00:28:37,520 --> 00:28:42,320 I would agree with that and expand on, there are a couple things that we've done here in 377 00:28:42,320 --> 00:28:44,760 Manitoba already since 2016. 378 00:28:44,760 --> 00:28:54,880 We've been doing prenatal testing for all that CBI for a second delivery as well. 379 00:28:54,880 --> 00:29:01,960 And that actually results in capturing a number of children who we find out are high. 380 00:29:01,960 --> 00:29:04,080 But it's very helpful. 381 00:29:04,080 --> 00:29:09,840 But like you in Saskatchewan, we also see women that we did find early in their pregnancy 382 00:29:09,840 --> 00:29:15,280 who got appropriately treated or responded neurologically and then got reinfected right 383 00:29:15,280 --> 00:29:16,880 around delivery. 384 00:29:16,880 --> 00:29:25,120 So without dealing with whatever the fundamental multifactorial issues are, we're not really 385 00:29:25,120 --> 00:29:28,360 going to get on top of that. 386 00:29:28,360 --> 00:29:31,800 And looking at the different populations, one of the things that we really have said 387 00:29:31,800 --> 00:29:36,400 is, well, maybe we really need to have a much more holistic Indigenous led approach here 388 00:29:36,400 --> 00:29:41,080 in Manitoba, which I think could apply in Alberta and Saskatchewan as well. 389 00:29:41,080 --> 00:29:45,840 So we have an initiative that just started very recently here, but we're hoping that 390 00:29:45,840 --> 00:29:49,520 that is much more well received in general. 391 00:29:49,520 --> 00:29:55,320 Because a lot of the more traditional methods of public health aren't quite achieving the 392 00:29:55,320 --> 00:29:56,920 goals we want it to. 393 00:29:56,920 --> 00:30:02,560 And like you, it's quite frustrating to see these children over and over infected. 394 00:30:02,560 --> 00:30:09,360 And it becomes normal, you said, whether you're used to subscribing to HIV medications, you 395 00:30:09,360 --> 00:30:13,480 can tell a person what you do for syphilis and you don't even have to think about it. 396 00:30:13,480 --> 00:30:14,480 Yeah, it's scary. 397 00:30:14,480 --> 00:30:15,480 Yeah. 398 00:30:15,480 --> 00:30:18,480 It's just not right. 399 00:30:18,480 --> 00:30:25,120 Yeah, no, I definitely, you know, I think the challenge we had here in Saskatchewan, 400 00:30:25,120 --> 00:30:27,720 like initially it was a lot of it was awareness, right? 401 00:30:27,720 --> 00:30:33,660 So like prescriber and physician awareness of testing and making sure to test. 402 00:30:33,660 --> 00:30:39,000 So we've also with the help of public health, been able to do a lot of prenatal testing. 403 00:30:39,000 --> 00:30:44,960 And I think because syphilis is on everybody's radar in the communities, people out in the 404 00:30:44,960 --> 00:30:49,240 communities, because we're not seeing them, you know, the patients out in the community. 405 00:30:49,240 --> 00:30:56,000 And so really having our kind of GPs, family doctors, internists who are actually involved 406 00:30:56,000 --> 00:31:03,560 in their care in maternal care, initially, you know, having them test and treat has really 407 00:31:03,560 --> 00:31:06,320 been part of what we've been focusing on. 408 00:31:06,320 --> 00:31:10,800 But apart from awareness, you know, I brought up something with our public health department 409 00:31:10,800 --> 00:31:16,560 here is that I don't think it's only awareness to a physician level or nursing level. 410 00:31:16,560 --> 00:31:23,720 I think we need to build awareness to the public and something that public health should 411 00:31:23,720 --> 00:31:29,160 deal, you know, is dealing with and is constantly doing that is connecting kind of our resources 412 00:31:29,160 --> 00:31:30,640 to our public. 413 00:31:30,640 --> 00:31:38,440 And so we have started to do some ad campaigns and, you know, local community discussions 414 00:31:38,440 --> 00:31:45,240 in regards to, you know, moms of this birthing age that are trying, you know, are trying 415 00:31:45,240 --> 00:31:51,280 to conceive or, you know, where we're seeing high rates of syphilis to really show them 416 00:31:51,280 --> 00:31:57,200 like what can syphilis do if you do treat yourself and what we can prevent your child 417 00:31:57,200 --> 00:31:58,460 from having. 418 00:31:58,460 --> 00:32:04,160 And I think that's been kind of the angle that we've switched our, at least our webinars 419 00:32:04,160 --> 00:32:06,080 and our awareness talks to. 420 00:32:06,080 --> 00:32:09,640 But again, it's still, you know, I mean, this is a huge problem. 421 00:32:09,640 --> 00:32:14,920 This is not going to be a one fix, one step, and then it's all fixed, right? 422 00:32:14,920 --> 00:32:17,360 So it's going to, like we just talked about, it's multifactorial. 423 00:32:17,360 --> 00:32:21,200 We're going to have to, yeah, I wish it was a snap of the finger. 424 00:32:21,200 --> 00:32:25,080 That would be, it would make our lives easier. 425 00:32:25,080 --> 00:32:26,340 But it's preventative, right? 426 00:32:26,340 --> 00:32:27,480 And that's why we're here today. 427 00:32:27,480 --> 00:32:35,520 We're talking about preventing syphilis because we all know that we can treat congenital syphilis. 428 00:32:35,520 --> 00:32:36,520 We've done it. 429 00:32:36,520 --> 00:32:37,520 We've seen the outcomes. 430 00:32:37,520 --> 00:32:39,000 We've seen our study. 431 00:32:39,000 --> 00:32:44,120 We've seen that most kids that we do identify get treated in the first week, you know, and 432 00:32:44,120 --> 00:32:46,920 they don't have poor outcomes because we can treat them. 433 00:32:46,920 --> 00:32:53,520 But we need to stop them from getting to the stage that Jared and I and Kirsten are seeing 434 00:32:53,520 --> 00:32:55,320 them at. 435 00:32:55,320 --> 00:33:00,760 We need to prevent all of that from even happening. 436 00:33:00,760 --> 00:33:06,880 And so I think that's kind of where our focus is with this study and implementing some of 437 00:33:06,880 --> 00:33:07,880 this. 438 00:33:07,880 --> 00:33:10,440 So I think it's really important to look at risk factors because that's where prevention 439 00:33:10,440 --> 00:33:11,840 really is going to aim at. 440 00:33:11,840 --> 00:33:16,420 So I'm really happy that we were able to have this discussion. 441 00:33:16,420 --> 00:33:20,320 So what is the future of our project? 442 00:33:20,320 --> 00:33:21,320 What are we doing? 443 00:33:21,320 --> 00:33:22,320 What's going forward? 444 00:33:22,320 --> 00:33:26,680 I mean, we're obviously still reporting. 445 00:33:26,680 --> 00:33:28,440 That's one of the things. 446 00:33:28,440 --> 00:33:34,720 And so is there a second kind of analysis that's coming up or? 447 00:33:34,720 --> 00:33:41,320 I think Jerry can speak to this a bit, but we're looking at seeing the cases that were 448 00:33:41,320 --> 00:33:45,960 reported and really sess out which of them would have been captured by the national definition 449 00:33:45,960 --> 00:33:50,640 versus those that were only captured by our study definition, just to sort of highlight 450 00:33:50,640 --> 00:33:58,960 how big of a discrepancy and how big the body of that submerged iceberg is in terms of congenital 451 00:33:58,960 --> 00:34:03,920 syphilis in Canada, at least an estimate of that. 452 00:34:03,920 --> 00:34:09,640 The other thing that we thought about is now we received a message loud and clear from 453 00:34:09,640 --> 00:34:18,920 pediatricians that the barriers of these pregnant people to engaging in prenatal care and preventing 454 00:34:18,920 --> 00:34:21,020 infection are not known to them. 455 00:34:21,020 --> 00:34:24,960 And so I think we have to go to these families and communities and partner with them to try 456 00:34:24,960 --> 00:34:33,480 to identify at a really granular and local level what the barriers they're experiencing 457 00:34:33,480 --> 00:34:42,160 are so that we can help develop those effective community led prevention strategies. 458 00:34:42,160 --> 00:34:47,200 So that's something that I think Jared and I are looking into in the future. 459 00:34:47,200 --> 00:34:52,600 And I'd be really excited to hear what those findings might be later. 460 00:34:52,600 --> 00:34:55,760 Yeah, that's fair. 461 00:34:55,760 --> 00:34:58,920 I think that we have a really great opportunity here. 462 00:34:58,920 --> 00:35:03,760 The study though is only going to be the next couple of months before it's shut down. 463 00:35:03,760 --> 00:35:09,080 I do encourage people if you have cases, it's important to provide that data. 464 00:35:09,080 --> 00:35:16,160 And I do really appreciate the burden of that is falling on certain provinces and practitioners 465 00:35:16,160 --> 00:35:17,160 to provide it. 466 00:35:17,160 --> 00:35:18,160 And that's true here too. 467 00:35:18,160 --> 00:35:23,160 I think that we can try to get this data if it's important. 468 00:35:23,160 --> 00:35:32,960 I think it's a very useful study in a number of ways. 469 00:35:32,960 --> 00:35:40,040 I think that there will be a need to sit down and then discuss what are we going to do next? 470 00:35:40,040 --> 00:35:45,000 Because we're going to need to measure if our interventions on a public health level 471 00:35:45,000 --> 00:35:48,000 are effective or not. 472 00:35:48,000 --> 00:35:52,360 Repeating this study down the road five years, what have you, might be an important step 473 00:35:52,360 --> 00:35:53,360 to take. 474 00:35:53,360 --> 00:35:54,360 Yeah. 475 00:35:54,360 --> 00:35:55,360 Yeah. 476 00:35:55,360 --> 00:36:00,760 And that's a really good, like important point that you bring up is that it has to be measurable. 477 00:36:00,760 --> 00:36:07,760 So it's difficult, right now, a lot of our public health interventions that we've implemented, 478 00:36:07,760 --> 00:36:13,760 there aren't a lot of repeat or relooks at how measurable this intervention was. 479 00:36:13,760 --> 00:36:15,880 And so is it really helping? 480 00:36:15,880 --> 00:36:19,840 Are we seeing cost effectiveness in our strategies? 481 00:36:19,840 --> 00:36:21,840 I think all of that. 482 00:36:21,840 --> 00:36:26,320 And so definitely here locally, I've done some talks recently with public health and 483 00:36:26,320 --> 00:36:31,560 I already informed them that we're having this episode and that I will be sharing it 484 00:36:31,560 --> 00:36:32,560 with them. 485 00:36:32,560 --> 00:36:37,440 So I urge people to share this with public health, your local public health departments, 486 00:36:37,440 --> 00:36:43,080 because I think some of this will bring out awareness and kind of help guide, is there 487 00:36:43,080 --> 00:36:46,280 some areas that maybe some of us aren't looking at, right? 488 00:36:46,280 --> 00:36:50,880 So some of the risk factors that we really need to tackle, are we looking at it from 489 00:36:50,880 --> 00:36:51,880 all angles? 490 00:36:51,880 --> 00:36:59,280 So before we end the episode, what are some of the kind of key messages that either of 491 00:36:59,280 --> 00:37:05,920 you would like to give our audience, our healthcare professionals out there, public health departments, 492 00:37:05,920 --> 00:37:11,480 kind of what you've learned from the study and may help smaller centers? 493 00:37:11,480 --> 00:37:18,520 Because I know that we don't all have resources in all centers to kind of implement every 494 00:37:18,520 --> 00:37:25,960 intervention, but if we can do anything, what would be some of the key points that you guys 495 00:37:25,960 --> 00:37:31,400 would let us give us an overview for? 496 00:37:31,400 --> 00:37:36,480 I mean, I think people are doing a tremendous job with the resources that they have available 497 00:37:36,480 --> 00:37:37,480 to them. 498 00:37:37,480 --> 00:37:40,040 So just keep up the good work. 499 00:37:40,040 --> 00:37:46,320 If you think about there being a possibility of a pregnant person becoming infected or 500 00:37:46,320 --> 00:37:57,120 reinfected with syphilis during pregnancy, like test, treat, identifying these cases 501 00:37:57,120 --> 00:38:05,240 early for congenital syphilis, it's just so important for their long-term outcomes that 502 00:38:05,240 --> 00:38:09,720 no baby should be discharged without knowing their syphilis status or at least having that 503 00:38:09,720 --> 00:38:10,720 test be pending. 504 00:38:10,720 --> 00:38:15,880 Yeah, and I think I would echo much of that. 505 00:38:15,880 --> 00:38:21,640 The people here in Manitoba and our public health MOHs have been really excellent. 506 00:38:21,640 --> 00:38:24,960 They have a number of infectious disease specialists, health analysts, and pediatricians who work 507 00:38:24,960 --> 00:38:29,320 together to try to make sure that we're getting the needed. 508 00:38:29,320 --> 00:38:34,240 We have a high prevalence of syphilis, so that's why we implemented doing regular prenatal 509 00:38:34,240 --> 00:38:35,240 testing. 510 00:38:35,240 --> 00:38:39,280 And it's important, like Karthik said, make sure that you actually get these carrots for 511 00:38:39,280 --> 00:38:44,360 all of these in the mom and babies as they're born, because that's really important to make 512 00:38:44,360 --> 00:38:47,280 a future decision on what's going on. 513 00:38:47,280 --> 00:38:53,200 Now, none of that necessarily helped in eliminating or preventing this, right? 514 00:38:53,200 --> 00:38:57,160 This is finding new cases, we're treating new cases. 515 00:38:57,160 --> 00:39:00,760 So I think that's going to take a little bit more of a coordinated effort. 516 00:39:00,760 --> 00:39:06,240 I think that many of the problems with where we have high numbers are looking at strategies 517 00:39:06,240 --> 00:39:10,960 and starting to look at some more novel strategies as well, which is encouraging. 518 00:39:10,960 --> 00:39:18,520 And then on the national stage, we have lots of work with definitions, exploratory diagnostics, 519 00:39:18,520 --> 00:39:20,560 and innovative ways of reaching populations. 520 00:39:20,560 --> 00:39:25,400 We have good research coming out talking about different ways we can potentially just treat 521 00:39:25,400 --> 00:39:26,400 and common in STDI. 522 00:39:26,400 --> 00:39:27,400 So there's lots being done. 523 00:39:27,400 --> 00:39:35,000 And I think that I'm seeing, and I think with the redirection of all of our resources post-COVID, 524 00:39:35,000 --> 00:39:41,200 we should be able to hopefully scratch the surface at the very least or make a good dent. 525 00:39:41,200 --> 00:39:42,840 Yeah, now you bring up a fair point. 526 00:39:42,840 --> 00:39:43,840 That's great. 527 00:39:43,840 --> 00:39:47,520 So I think definitely I learned a lot from this study. 528 00:39:47,520 --> 00:39:54,400 I have obviously am in a center where we are seeing a lot of congenital syphilis. 529 00:39:54,400 --> 00:39:56,560 We've done a lot from our public health. 530 00:39:56,560 --> 00:40:02,240 We have a good relationship, I think, ID and public health here that we're able to, we're 531 00:40:02,240 --> 00:40:05,960 lucky that we can implement some of the strategies. 532 00:40:05,960 --> 00:40:07,640 And I think we'll continue to work on those. 533 00:40:07,640 --> 00:40:14,240 But I think definitely looking at some of the risk factors from this study gave me a 534 00:40:14,240 --> 00:40:20,160 good kind of overview of maybe some of the areas that we are missing. 535 00:40:20,160 --> 00:40:26,120 And so hopefully with our next set of analysis, we'll get more information and we'll continue 536 00:40:26,120 --> 00:40:28,000 to report on our end. 537 00:40:28,000 --> 00:40:31,960 So I really want to thank both of you for coming on the podcast. 538 00:40:31,960 --> 00:40:35,640 This was much awaited podcast. 539 00:40:35,640 --> 00:40:41,680 I've had a lot of requests actually from some of the local physicians here, those that have 540 00:40:41,680 --> 00:40:48,040 been reporting just to kind of see what, where is the preliminary, like, you know, what all 541 00:40:48,040 --> 00:40:52,040 our hard work of reporting, what are we seeing? 542 00:40:52,040 --> 00:40:59,880 So I think it was fantastic to have two of our experts in the area on our podcast today. 543 00:40:59,880 --> 00:41:03,480 Before we end the episode, I do want to let everybody know that this is an informational 544 00:41:03,480 --> 00:41:12,320 podcast and there's no way to endorse a product or study and is not in place of an infectious 545 00:41:12,320 --> 00:41:14,480 disease consultation. 546 00:41:14,480 --> 00:41:17,180 Thanks Jared and thanks Carson. 547 00:41:17,180 --> 00:41:22,000 Thank you, Dr. Pirawal and a special thank you to Dr. Bullard and Dr. Kruger. 548 00:41:22,000 --> 00:41:23,800 Have a topic suggestion? 549 00:41:23,800 --> 00:41:29,800 Email us at thecanadianbreakpoint.gmail.com and be sure to follow us on Twitter at CA 550 00:41:29,800 --> 00:41:30,800 Breakpoint. 551 00:41:30,800 --> 00:41:57,800 See you again soon at the Canadian Breakpoint.