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Salomè S, Cambriglia MD, Montesano G, Capasso L, Raimondi F. Congenital Syphilis: A Re-Emerging but Preventable Infection. Pathogens 2024; 13:481. [PMID: 38921779 PMCID: PMC11206692 DOI: 10.3390/pathogens13060481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital syphilis presents a significant global burden, contributing to fetal loss, stillbirth, neonatal mortality, and congenital infection. Despite the target established in 2007 by the World Health Organization (WHO) of fewer than 50 cases per 100,000 live births, the global incidence is on the rise, particularly in low- and middle-income regions. Recent data indicate a rate of 473 cases per 100,000 live births, resulting in 661,000 total cases of congenital syphilis, including 355,000 adverse birth outcomes such as early fetal deaths, stillbirths, neonatal deaths, preterm or low-birth-weight births, and infants with clinical congenital syphilis. Alarmingly, only 6% of these adverse outcomes occurred in mothers who were enrolled, screened, and treated. Unlike many neonatal infections, congenital syphilis is preventable through effective antenatal screening and treatment of infected pregnant women. However, despite available screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in various countries, congenital syphilis remains a pressing public health concern worldwide. This review aims to summarize the current epidemiology, transmission, and treatment of syphilis in pregnancy, as well as to explore global efforts to reduce vertical transmission and address the reasons for falling short of the WHO elimination target.
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Affiliation(s)
- Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (M.D.C.); (G.M.); (L.C.); (F.R.)
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Liu Y, Posey DL, Weinberg MS, Phares CR. Tuberculosis in United States-Bound Follow-to-Join Asylees, 2014-2019. Am J Trop Med Hyg 2024; 110:999-1005. [PMID: 38531107 PMCID: PMC11066364 DOI: 10.4269/ajtmh.23-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/20/2023] [Indexed: 03/28/2024] Open
Abstract
Persons may seek asylum in the United States or at a U.S. port of entry. Principal asylees are those who are granted asylum status. Their spouse and unmarried children under 21 years of age may be granted asylum if accompanying, or following to join, the principal asylees. U.S.-bound follow-to-join asylees must undergo an overseas medical examination that includes tuberculosis (TB) screening. Culture-based overseas TB screening in U.S.-bound follow-to-join asylees has not been evaluated. We evaluated data from overseas TB screening in 19,088 arrivals of follow-to-join asylees during 2014-2019 and assessed data from their postarrival evaluation, which is recommended for those at risk for TB. Of 19,088 arrivals of follow-to-join asylees, 29 (152 cases/100,000 persons) met criteria for class B0 TB (recent completion of TB treatment overseas) and 340 (1,781 cases/100,000 persons) met criteria for class B1 pulmonary TB (chest radiograph/clinical symptoms suggestive of TB but negative sputum cultures overseas). Of 6,847 persons aged 2 to 14 years from countries with a WHO-estimated TB incidence of ≥20 cases/100,000 population/year, 408 (6.0%) were classified as class B2 latent TB infection (LTBI). Postarrival evaluations were completed in 44.8%, 51.5%, and 40.4% of persons with class B0 TB, class B1 TB, and class B2 LTBI, respectively. In conclusion, culture-based overseas TB screening in U.S.-bound follow-to-join asylees is effective in identifying those with TB (class B0 TB) or those at risk for TB (class B1 TB and class B2 LTBI). Completion of postarrival evaluation for newly arrived follow-to-join asylees was less frequent than that reported for immigrants and refugees.
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Affiliation(s)
- Yecai Liu
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Drew L. Posey
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michelle S. Weinberg
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina R. Phares
- Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Stafford IA, Workowski KA, Bachmann LH. Syphilis Complicating Pregnancy and Congenital Syphilis. N Engl J Med 2024; 390:242-253. [PMID: 38231625 DOI: 10.1056/nejmra2202762] [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: 01/19/2024]
Affiliation(s)
- Irene A Stafford
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Kimberly A Workowski
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
| | - Laura H Bachmann
- From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, McGovern Medical School at UT Health, Houston (I.A.S.); and the Department of Medicine, Division of Infectious Diseases, Emory University (K.A.W.), and the Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention - both in Atlanta (K.A.W., L.H.B.)
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Jain R, Stone GS, Gartland MG. Medical Care for Newly Arrived Displaced Persons. NEJM EVIDENCE 2023; 2:EVIDra2200286. [PMID: 38320529 DOI: 10.1056/evidra2200286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Care for Displaced PersonsThe United Nations High Commissioner for Refugees reports that more than 100 million people have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Displacement has profound health impacts. Here, Jain and colleagues review medical care for newly displaced persons.
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Affiliation(s)
- Radhika Jain
- Department of Medicine, Division of General Medicine, Washington University School of Medicine, St. Louis
| | - Geren S Stone
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
| | - Matthew G Gartland
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Pediatrics, Massachusetts General Hospital, Boston
- Center for Global Health, Massachusetts General Hospital, Boston
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Schweon SJ. Diphtheria update. Nurse Pract 2023; 48:35-39. [PMID: 37751614 DOI: 10.1097/01.npr.0000977916.64595.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
ABSTRACT Travelers from parts of the world where diphtheria is endemic and vaccines are underutilized or unavailable may carry diphtheria, become ill, and spread the disease. This article provides an overview of diphtheria as well as management updates that are particularly critical amid new travel records and a climate of vaccine hesitancy.
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Affiliation(s)
- Steven J Schweon
- Steven J. Schweon is an RN and board-certified infection preventionist who specializes in the acute care, long-term care, and behavioral health clinical settings. Topics of interest include vaccine preventable diseases, outbreak prevention, surveillance, hand hygiene, and environmental hygiene
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Chen J, Marusinec R, Brown R, Shiau R, Jaganath D, Chitnis AS. Epidemiology of Culture-Negative Pulmonary Tuberculosis-Alameda County, 2010-2019. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:353-360. [PMID: 36867649 PMCID: PMC10038828 DOI: 10.1097/phh.0000000000001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
CONTEXT Patients with culture-negative pulmonary TB (PTB) can face delays in diagnosis that worsen outcomes and lead to ongoing transmission. An understanding of current trends and characteristics of culture-negative PTB can support earlier detection and access to care. OBJECTIVE Describe epidemiology of culture-negative PTB. DESIGN, SETTING, PARTICIPANTS We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases. RESULTS During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 ( P for trend <.01), while the incidence of culture-positive PTB reduced by 37% (6.5/100 000 to 4.1/100 000, P for trend =.1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children <15 years old vs 1.1%; P < .01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P < .01), and have a TB contact (11.2% vs 2.9%; P < .01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P < .01) or have cavitation on chest imaging (13.1% vs 38.8%; P < .01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P < .01). CONCLUSIONS The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.
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Affiliation(s)
- Jennie Chen
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Rachel Marusinec
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Robert Brown
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Rita Shiau
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
| | - Devan Jaganath
- Division of Pediatric Infectious Diseases, University of California, San Francisco, San Francisco, CA
- Center for Tuberculosis, University of California, San Francisco, CA
| | - Amit S. Chitnis
- Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
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