CDC Expert at Forefront of Effort to Protect Infants from Syphilis and HIV

Mary Kamb, Associate Director for Global Activities in CDC’s National Center for HIV/AIDS Division of STD Prevention, found herself squarely in the middle of two historic moments earlier this year. One was by design and the result years of hard work, collaboration, and disciplined science. The other was unexpected and unforeseen.

Connecting them both is Cuba and the potential for improving people’s health in that country, across the Americas, and beyond.

In June 2015 Cuba became the first country in the world to earn official recognition from the World Health Organization (WHO) that it had eliminated mother-to-child transmission (MTCT) of HIV and syphilis. Kamb was part of a team of public health experts under the aegis of the Pan American Health Organization (PAHO) that worked closely with health officials in Cuba and from across the region to document, analyze, and verify the program and its results.

“This is a major achievement that will not only make mothers and babies healthier in Cuba, but hopefully in countries worldwide, where more than 240,000 babies are born each year with HIV and another 350,000 perinatal deaths are caused by untreated maternal syphilis,” said Kamb, who has been involved in the effort since it began in 2010. “The lessons we learned and the techniques we refined in Cuba can be used in other countries to address the terrible effects of HIV and syphilis that are passed from mother to child.”

That news alone was notable. But then, one month later in July, came something unexpected – the United States and Cuba announced relations between the two countries would be normalized. The announcement marked a dramatic step forward toward ending more than 50 years of estranged coexistence and opening the door to public health experts from the United States and Cuba working together more closely and more frequently.

President Obama noted the possibility on September 23 after meeting with Pope Francis at the White House. Among areas where the Vatican and the United States have shared interests, the President highlighted the potential for improving people’s health in Haiti. “The United States and Cuba share common interests, among them the health and welfare of the people of Haiti,” the President and the Pope said in a joint announcement.

“As with our previous cooperation on Ebola, this provides a unique opportunity to engage with Cuban medical professionals and to discuss opportunities for future cooperation. This cooperation demonstrates how our continued normalization of relations with Cuba can help us advance our interests in the Americas,” the announcement stated.

In Kamb’s case, her part in the assisting Cuba eliminate MTCT of HIV and syphilis have already produced tangible results.

With an accomplished 25-year history at CDC and a focus on preventing sexually transmitted disease, Kamb is highly regarded. She is a member of CDC’s Maternal and Child Health Steering Group and co-chair of the Maternal and Perinatal Working Group, led global activities in the Division of STD Prevention for nine years, and has deep experience for CDC, both domestically and overseas, where she served as Vietnam Country Director for four years. She also has close ties to PAHO, working with the organization for the last six years to eliminate congenital syphilis worldwide.

With those achievements it wasn’t surprising she was selected to join the 15-member PAHO technical mission that traveled to Cuba in March and that she was asked to lead the team evaluating the data in the effort to eliminate transfer of HIV and syphilis to infants.

The PAHO team that arrived in Cuba in March closely reviewed four primary elements of Cuba’s campaign to eliminate MTCT of HIV and congenital syphilis – the quality and consistency of data; the overall program design; laboratory availability and performance; and ensuring human rights.

The time in Cuba was a major reason WHO ultimately declared in June 2015 that Cuba had eliminated MTCT of HIV and syphilis.

It’s not an easy standard to meet.

One of the requirements for elimination of MTCT of HIV infections is that there can be no more than 30 cases per 100,000 live births, and no more than 2 percent perinatal transmission. For elimination of MTCT of syphilis, the congenital syphilis case rate (including stillbirths) must be no more than 50 cases per 100,000 live births. A country must also be able to demonstrate that at least 95 percent of pregnant women receive at least one antenatal visit, are tested for both HIV and syphilis, and for those who test positive for one or both diseases, at least 95 percent of women receive adequate treatment sufficiently promptly to prevent adverse pregnancy outcomes.

In order to certify the results, PAHO officials spent five days surveying the program in three provinces, including Havana, and examined the central elements of the effort. At the center was early access to prenatal care, HIV and syphilis testing and, if a positive result was returned, treatment.

“Even though Cuba is a low income country it has managed to achieve a very high standard of antenatal care,” Kamb said, pointing to the fact that essentially 100 percent of mothers in Cuba receive care, and most before the end of their first trimester of pregnancy.

“What we found in Cuba was that elimination of MTCT of HIV and syphilis as well as very low maternal and infant mortality overall, makes the case for countries investing in antenatal programs,” she said. “It’s exciting that the first country to be officially recognized for eliminating MTCT of HIV and syphilis is here in the Americas. This region is showing the world how it can be done. This is really a huge moment not just in Cuba and the Americas but globally.”

The challenge now is to replicate the results in other places.

One of those challenge is penicillin shortages. One surprising finding was that Cuba sometimes had a shortage of penicillin, the frontline medicine for treating syphilis. “That was a surprise,” Kamb said. “We thought it was on every country’s essential drug list and that it was fully available. That’s not always the case, and now we’re realizing other countries are also experiencing penicillin shortages.”

That’s where the second – and unexpected – development will help, too. The thawing of relations between the United States and Cuba will make it easier to collaborate on matters going forward, including those affecting public health.