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Dewart G, Muller J, Phillips JC, Banaszak D, Caine V. Interventions in maternal syphilis care globally: A scoping review. Health Care Women Int 2024:1-20. [PMID: 38180353 DOI: 10.1080/07399332.2023.2294815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
Infectious and Congenital Syphilis rates continue to rise globally. Current recommendations for syphilis screening and treatment may be insufficient, and there is a pressing need for improved programs and services to address the increase in cases. A scoping review was conducted to examine approaches to maternal syphilis screening and treatment. Theoretical underpinnings and the key characteristics of these interventions were studied to identify gaps in the existing literature to guide future research. Developing a modified version of the socio-ecological model to guide data analysis, we included 33 academic studies spanning 31 years, covering a range of interventions, programs, and policies globally. We highlight key facets of interventions aligning with the five levels of the modified model that include: individual, interpersonal, institutional, community and policy. In this review, we provide valuable insights into the characteristics and principles of maternal syphilis screening and treatment interventions.
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Affiliation(s)
- Georgia Dewart
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jessica Muller
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - J Craig Phillips
- School of Nursing, Faculty of Health Sciences, Université d'Ottawa | University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle Banaszak
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Johnson KA, Burghardt NO, Snyder RE, Plotzker RE, Imp BM, Murphy R, Jacobson K, Tang EC. Comparing 7-Day Versus 6-8-Day Penicillin Treatment Intervals Among Pregnant People With Syphilis of Late or Unknown Duration: No Difference Found in Incidence of Congenital Syphilis. Open Forum Infect Dis 2023; 10:ofad300. [PMID: 37389226 PMCID: PMC10300633 DOI: 10.1093/ofid/ofad300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
Background Guidelines recommend that pregnant patients with syphilis of late/unknown duration be treated with benzathine penicillin G, dosed as 3 weekly intramuscular injections (BPGx3) given ideally at strict 7-day intervals. Given limited pharmacokinetic data, it is unknown whether more flexible BPG treatment intervals might be effective in preventing congenital syphilis (CS). Methods We used California surveillance data to identify birthing parent/infant dyads wherein the pregnant parent had syphilis of late/unknown duration between January 1, 2016 - June 30, 2019. We divided the dyads into 3 groups based on prenatal treatment: (1) BPGx3 at strict 7-day intervals, (2) BPGx3 at 6-8 day intervals, and (3) no/inadequate treatment. We then compared CS incidence among infants in each group. Results We analyzed 1,092 parent/infant dyads: 607 (55.6%) in the 7-day treatment group, 70 (6.4%) in the 6-8 day treatment group, and 415 (38.0%) in the no/inadequate treatment group. The incidence proportion of infants meeting CS criteria in each group was, respectively, 5.6%, 5.7%, and 36.9%. Compared with BPGx3 at 7-day intervals, the odds of CS were 1.0 [95% CI 0.4-3.0] in the 6-8 day group and 9.8 [95% CI 6.6-14.7] in the no/inadequate treatment group. Conclusions Prenatal BPGx3 at 6-8 days was no more likely to lead to CS in infants than 7-days. These findings hint that 6-8-day intervals might be adequate to prevent CS among pregnant people with syphilis of late/unknown duration. Consequently, it is possible that CS evaluation beyond an RPR at delivery may be unnecessary in asymptomatic infants whose parents received BPGx3 at 6-8 days.
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Affiliation(s)
- Kelly A Johnson
- Correspondence: Kelly A. Johnson, MD, MPH, Division of Infectious Diseases, University of California San Francisco, 513 Parnassus Ave, Room S380, San Francisco CA 94143 (); Nicole O. Burghardt, MPH, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Pkwy, Bldg P, Richmond, CA 94804 ()
| | - Nicole O Burghardt
- Correspondence: Kelly A. Johnson, MD, MPH, Division of Infectious Diseases, University of California San Francisco, 513 Parnassus Ave, Room S380, San Francisco CA 94143 (); Nicole O. Burghardt, MPH, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Pkwy, Bldg P, Richmond, CA 94804 ()
| | - Robert E Snyder
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA
| | - Rosalyn E Plotzker
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Brandon M Imp
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Ryan Murphy
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA
| | - Kathleen Jacobson
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California, USA
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Plotzker RE, Burghardt NO, Murphy RD, McLean R, Jacobson K, Tang EC, Seidman D. Congenital syphilis prevention in the context of methamphetamine use and homelessness. Am J Addict 2022; 31:210-218. [PMID: 35340101 PMCID: PMC9507168 DOI: 10.1111/ajad.13265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Congenital syphilis (CS) is increasing in the United States and is associated with intersecting social and structural determinants of health. This study aimed to delineate birthing parent characteristics associated with CS in an adjusted model. METHODS (N = 720): People diagnosed with syphilis during pregnancy from 2017 to 2018 who were interviewed and linked to infants in the California state surveillance system were included (herein, "birthing parents"). Sociodemographic and clinical CS risk factors informed a stepwise multivariable logistic regression model in which the outcome of interest was infants born with CS. CS prevention continuums delineated the proportion of pregnant people with syphilis who completed steps (e.g., prenatal care entry, syphilis testing, treatment) needed to prevent CS; the outcome was delivering an infant without CS. We stratified continuums by homelessness and methamphetamine use to explore differences in CS outcomes. RESULTS Of 720 birthing parents, 245 (34%) delivered an infant with CS. Although CS was initially associated with homelessness (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.6, 4.0) and methamphetamine use (OR = 2.1, 95% CI: 1.4, 3.1), the addition of prenatal care into a final adjusted model attenuated these associations to not significant. In CS prevention continuums, delivering an infant without CS was less likely for people who reported methamphetamine use (p < .001) and/or homelessness (p < .001). However, when examining only those who received prenatal care, statistical differences for these predictors no longer existed. In the final adjusted model the following were associated with CS: no prenatal care (OR = 16.7, 95% CI: 9.2, 30.3) or late prenatal care (OR = 2.9, 95% CI: 1.9, 4.2); early stage of syphilis (OR = 2.6, 95% CI: 1.8, 3.7); living in Central California (OR = 2.1, 95% CI: 1.1, 4.2). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE This is the first analysis to explore birthing parent characteristics associated with delivering an infant with CS in an adjusted model. We demonstrate that prenatal care, when accessed, can result in effective CS prevention among people who are unhoused and/or using methamphetamine equally well compared to counterparts without these risk factors.
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Affiliation(s)
- Rosalyn E Plotzker
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Nicole O Burghardt
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Ryan D Murphy
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Rachel McLean
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Kathleen Jacobson
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Eric C Tang
- California Department of Public Health, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, Richmond, California, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Amorim EKR, Matozinhos FP, Araújo LA, Silva TPRD. Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study. ACTA ACUST UNITED AC 2021; 30:e2021128. [PMID: 34644777 DOI: 10.1590/s1679-49742021000400006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the trend of notifications of gestational and congenital syphilis in Minas Gerais, Brazil, from 2009 to 2019. METHODS This was an ecological time series study which took the state of Minas Gerais as its unit of analysis, based on data reported on the Notifiable Health Conditions Information System (SINAN). The Prais-Winsten autoregressive model was used to verify trends. RESULTS 20,348 cases of gestational syphilis and 11,173 cases of congenital syphilis were reported. Average percentage annual increase was 36.7% (95%CI 32.5;41.0), for gestational syphilis incidence rates, and 32.8% (95%CI 28.0;37.8) for congenital syphilis incidence rates (p<0.001). CONCLUSION The temporal trend analysis showed that gestational and congenital syphilis incidence rates had significant increasing trends, which may be related to inadequate treatment or failure to treat syphilis during pregnancy.
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Affiliation(s)
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
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Belo MMDA, Oliveira CMD, Barros SCD, Maia LTDS, Bonfim CVD. Estimated underreporting of congenital syphilis deaths in Recife, Pernambuco, Brazil, 2010-2016: linkage between the mortality information system and the notifiable health conditions information system. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2020501. [PMID: 34468564 DOI: 10.1590/s1679-49742021000300009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate underreporting of fetus and infant deaths having congenital syphilis as their underlying or associated cause in Recife, Pernambuco, Brazil, between 2010-2016. METHODS Probabilistic database linkage was carried out between congenital syphilis cases recorded on the Notifiable Health Conditions Information System and fetus and infant deaths due to congenital syphilis recorded on the Mortality Information System. RESULTS 170 fetus and infant congenital syphilis deaths were matched. Fetus and infant deaths due to congenital syphilis were underreported by 80.9% on the Notifiable Health Conditions Information System and by 7.0% on the Mortality Information System, accounting for an increase of 2.3% and 7.0% in the final databases, respectively. CONCLUSION The underreporting identified compromises knowledge of the true magnitude of deaths caused by this disease.
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Araújo MAL, Esteves ABB, Rocha AFB, Silva Junior GBD, Miranda AE. Factors associated with prematurity in reported cases of congenital syphilis. Rev Saude Publica 2021; 55:28. [PMID: 34008782 PMCID: PMC8102023 DOI: 10.11606/s1518-8787.2021055002400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.
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Affiliation(s)
- Maria Alix Leite Araújo
- Universidade de Fortaleza. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
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Hu F, Guo SJ, Lu JJ, Hua NX, Song YY, Lin SF, Zhu S. New screening approach to detecting congenital syphilis in China: a retrospective cohort study. Arch Dis Child 2021; 106:231-237. [PMID: 33355158 PMCID: PMC7907569 DOI: 10.1136/archdischild-2020-320549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.
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Affiliation(s)
- Fang Hu
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuai-Jun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jian-Jun Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China,Department of Medical Affairs, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Ning-Xuan Hua
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan-Yan Song
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui-Fang Lin
- Department of Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui Zhu
- Department of Medical Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, China
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Nunes PS, Guimarães RA, Rosado LEP, Marinho TA, Aquino ÉCD, Turchi MD. Temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás, Brazil, 2007-2017: an ecological study. ACTA ACUST UNITED AC 2021; 30:e2019371. [PMID: 33503212 DOI: 10.1590/s1679-49742021000100002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/28/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze temporal trend and spatial distribution of syphilis in pregnancy and congenital syphilis in Goiás State, Brazil, between 2007 and 2017. METHODS This was an ecological time series and spatial distribution study with data obtained from the Notifiable Health Conditions Information System. Prais-Winsten Regression was used to analyze indicator trends by health macro-region. Descriptive spatial analysis was performed to verify case distribution in three different years in the period. RESULTS Between 2007 and 2017, 7,679 cases of syphilis in pregnancy and 1,554 congenital syphilis cases were reported. A rising trend was found in the rates of syphilis in pregnancy (annual percent change [APC] = 18.0 - 95% confidence interval [95%CI] 15.3;20.8) as well as in congenital syphilis rates (APC=16.8 - 95%CI 20.1;33.8); and a 326% increase in the number of municipalities with a congenital syphilis incidence rate >0.5/1,000 live births. CONCLUSION Growth in syphilis in pregnancy and congenital syphilis detection rates was identified, as was growth in the number of municipalities reporting cases.
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Affiliation(s)
- Patrícia Silva Nunes
- Instituto Federal de Educação, Ciência e Tecnologia de Goiás, Núcleo de Estudos e Pesquisas em Promoção da Saúde, Goiânia, GO, Brasil
| | - Rafael Alves Guimarães
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Luiza Emylce Pelá Rosado
- Secretaria de Estado da Saúde de Goiás, Hospital Materno-Infantil de Goiânia, Goiânia, GO, Brasil
| | - Tamíris Augusto Marinho
- Instituto Federal de Educação, Ciência e Tecnologia de Goiás, Núcleo de Estudos e Pesquisas em Promoção da Saúde, Goiânia, GO, Brasil
| | - Érika Carvalho de Aquino
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | - Marília Dalva Turchi
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
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Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6661] [Impact Index Per Article: 1665.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING Bill & Melinda Gates Foundation.
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Williamson DA, Chen MY. Emerging and Reemerging Sexually Transmitted Infections. Reply. N Engl J Med 2020; 383:794-795. [PMID: 32813965 DOI: 10.1056/nejmc2022699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Figueiredo DCMMD, Figueiredo AMD, Souza TKBD, Tavares G, Vianna RPDT. [Relationship between the supply of syphilis diagnosis and treatment in primary care and incidence of gestational and congenital syphilis]. CAD SAUDE PUBLICA 2020; 36:e00074519. [PMID: 32215510 DOI: 10.1590/0102-311x00074519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
Brazil has reported an increase in the incidence of both gestational and congenital syphilis, posing a serious public health problem in the country. The study aimed to analyze the relationship between the supply of syphilis diagnosis and treatment in primary care and the incidence rates of gestational and congenital syphilis. An ecological study analyzed these incidence rates and the coverage of diagnostic and therapeutic measures in primary care. The study sample consisted of municipalities (counties) with population over 20,000, with coverage by primary care over 50%, and where the majority of the teams were assessed in the second cycle of the National Program for Improvement of Access and Quality of Basic Care. Analysis of the effectiveness of detection and treatment measures was based on the development of the Index of Variation in Vertical Syphilis Transmission. The administration of penicillin and application of the rapid test in these municipalities showed median rates of 41.9% and 67.14%, respectively, with regional differences. Median incidence of gestational syphilis was 6.24 (IQR: 2.63-10.99) in municipalities with a higher supply of the rapid test and 3.82 (IQR: 0.00-8.21) in those with a lower supply, indicating an increase in detection capacity. Municipalities with a reduction in vertical transmission showed higher median rates of teams with supply of rapid testing and (83.33%; IQR: 50.00-100.00) and administration of penicillin (50.00%; IQR: 11.10-87.50), demonstrating a relationship between these measures and the reduction in congenital syphilis. The findings indicate the need to expand these services and to reinforce the importance of reducing vertical transmission.
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Affiliation(s)
| | | | - Tanise Kely Bezerra de Souza
- Universidade Federal da Paraíba, João Pessoa, Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Graziela Tavares
- Programa de Pós-graduação em Políticas Públicas em Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Rodrigo Pinheiro de Toledo Vianna
- Universidade Federal da Paraíba, João Pessoa, Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
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Affiliation(s)
- Khalil G Ghanem
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Sanjay Ram
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
| | - Peter A Rice
- From the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (K.G.G.); and the Department of Medicine and Division of Infectious Diseases and Immunology, University of Massachusetts Medical Center, Worcester (S.R., P.A.R.)
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Abstract
Since a brief low in 1998, reported cases of syphilis have continued to grow in the US. As primary care providers, NPs are at the forefront of the battle to eliminate syphilis. This article reviews the stages of this infection, diagnosis nuances, and treatment guidelines.
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Cárdenas Dávila E, Bedoya Marrugo EA, Domínguez YA, Elin Manrique J. Identificación de acciones de salud en el Programa de Control de Sífilis en gestantes, Cartagena de Indias, 2016. NOVA 2020. [DOI: 10.22490/24629448.3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fundamento. La Sífilis Congénita es una infección causada por la diseminación hematógena del Treponema pallidum de la gestante infectada al feto. Se conoce que la transmisión materna puede ocurrir en cualquier momento del embarazo, por lo que el control de la enfermedad en la gestante es vital en la atención prenatal. Objetivo. Identificar el cumplimiento de acciones de salud comprendidas en el Programa de Control de Sífilis en gestantes de la ciudad de Cartagena de Indias, primer semestre del 2016. Materiales y métodos: Estudio observacional descriptivo transversal. Se evaluaron 781 gestantes inscritas en control prenatal de la ciudad, a través de las instituciones prestadoras de servicios de salud (IPS) y empresas promotoras de salud (EPS). Resultados: Concluyeron la gestación 358 (45.8%) de las gestantes estudiadas. 25 (6.5%) del total, no se realizaron la VDRL intraparto. Durante el primer trimestre del embarazo, el 99.6% de las evaluadas resultaron VDRL no reactivas (NR). Mientras que en el segundo trimestre fueron evaluadas, el 67.5% y el 57,4%, respectivamente; resultando VDRL reactiva (R) una (0.1%) durante ambos semestres. Del segundo al tercer trimestre de la gestación no se incrementó el número de gestantes no evaluadas (98; 12,5%) y (63; 8, 1%), sin embargo, sí se incrementó (55; 19.8%) (269; 34.4%), respectivamente, el número de las gestantes que están a la espera del tiempo para realizar la prueba. No existió co-infección Sífilis/VIH/SIDA. Conclusiones. El control de la sífilis durante la atención prenatal fue deficiente dado por la alta tasa de no adherencia al cumplimiento de asistencia a la consulta por la gestante, como la no realización de la prueba acorde al tiempo establecido por parte del equipo de salud.
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Elimination of Mother-to-child Transmission of Syphilis: Challenge and Solution. MATERNAL-FETAL MEDICINE 2019. [DOI: 10.1097/fm9.0000000000000018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Melenotte C, Drancourt M, Gorvel JP, Mège JL, Raoult D. Post-bacterial infection chronic fatigue syndrome is not a latent infection. Med Mal Infect 2019; 49:140-149. [DOI: 10.1016/j.medmal.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/15/2019] [Indexed: 01/20/2023]
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Purcell RA, Butters CT, Osowicki J. Follow the lesion: A missed opportunity in infancy. J Paediatr Child Health 2018; 54:1396-1397. [PMID: 30506782 DOI: 10.1111/jpc.2_14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rachael A Purcell
- Department of Paediatric Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.,School of Medicine Sydney, University of Notre Dame, Sydney, New South Wales, Australia
| | - Coen T Butters
- Department of Paediatric Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Joshua Osowicki
- Department of Paediatric Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Although the U.S. syphilis epidemic is concentrated among men who have sex with men, the number of congenital syphilis cases and the primary and secondary syphilis rate among women both doubled in recent years.
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Affiliation(s)
| | - William C Miller
- College of Public Health, The Ohio State University, Columbus, OH
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