Turning off the tap: sustaining elimination of congenital syphilis through the programme targeting high-risk groups

Syphilis

Syphilis is a sexually and vertically transmitted bacterial infection caused by the bacterium Treponema pallidum. Its prevalence is high in low-income and middle-income countries, and its incidence has increased in high-income countries in the last few decades among men who have sex with men. Syphilis is a major cause of adverse pregnancy outcomes in low-income and middle-income countries. Clinical features include a primary chancre at the point of inoculation, followed weeks later by the rash of secondary syphilis, a latent period, and in some cases, involvement of the eyes, CNS, and cardiovascular systems. It is diagnosed serologically. A single intramuscular dose of long-acting benzathine penicillin is recommended for people who have had syphilis for less than 1 year and longer courses for people with late latent syphilis. Control strategies include screening and treatment of all pregnant women, and targeted interventions for groups at high risk. Vaccine development, research on antibiotic prophylaxis, and digital messaging as prevention strategies are ongoing.

Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study

OBJECTIVE

To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques.

DESIGN

Ecological study.

SETTINGS

This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study.

PRIMARY OUTCOME MEASURES

The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan.

RESULTS

From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk.

CONCLUSION

This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.

Eliminating Mother-to-Child Transmission of Syphilis: Chinese Practice before and during COVID-19 Pandemics

Mother-to-child transmission (MTCT) of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries. In 2007, WHO launched the global elimination of MTCT (EMTCT) of syphilis. Given the high burden of congenital syphilis, China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis. The congenital syphilis incidence rate per 100 000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019. However, due to the global pandemic of COVID-19, the current measures for eliminating MTCT of syphilis are great challenged. In this article, we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years, point out that we have made remarkable achievements due to the national health policy support and strong leadership of the government. In the context of COVID-19 pandemics, strengthening emergency response to the regional outbreaks of COVID-19 and adopting safe, rapid, early and high-quality clinical care to ensure that 100% of pregnant women receive prenatal syphilis testing services, ensuring the availability of Benzathine penicillin for the treatment, and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are key measures to determine the effect of MTCT of syphilis. Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis.