Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

Abstract

Background Congenital syphilis (CS) is a major and avoidable cause of neonatal death worldwide. In this study, we aimed to estimate excess all-cause mortality in children under 5 years with CS compared to those without CS. Methods and findings In this population-based cohort study, we used linked, routinely collected data from Brazil from January 2011 to December 2017. Cox survival models were adjusted for maternal region of residence, maternal age, education, material status, self-declared race and newborn sex, and year of birth and stratified according to maternal treatment status, non-treponemal titers and presence of signs and symptoms at birth. Over 7 years, a total of 20 057 013 live-born children followed up (through linkage) to 5 years of age, 93 525 were registered with CS, and 2 476 died. The all-cause mortality rate in the CS group was 7·84/1 000 person-years compared with 2·92/1 000 person-years in children without CS, crude hazard ratio (HR) = 2·41 (95% CI 2·31 to 2·50). In the fully adjusted model, the highest under-five mortality risk was observed among children with CS from untreated mothers HR = 2·82 (95% CI 2·63 to 3·02), infants with non-treponemal titer higher than 1:64 HR = 8·87 (95% CI 7·70 to 10·22), and children with signs and symptoms at birth HR = 7·10 (95% CI 6·60 to 7·63). Among children registered with CS, CS was recorded as the underlying cause of death in 33% (495/1 496) of neonatal, 11% (85/770) of postneonatal, and 2·9% (6/210) of children 1 year of age. The main limitations of this study were the use of a secondary database without additional clinical information and the potential misclassification of exposure status. Conclusions This study showed an increased mortality risk among children with CS that goes beyond the first year of life. It also reinforces the importance of maternal treatment that infant non-treponemal titers and the presence of signs and symptoms of CS at birth are strongly associated with subsequent mortality. Trial registration Observational study.

Uma abordagem transversal sobre Sífilis Congênita em Sergipe: sinais e sintomas e suas implicações para a Saúde Neonatal

“…A taxa de mortalidade em todas as faixas etárias de crianças com sífilis congênita abaixo de 5 anos aumenta consideravelmente na presença de sintomas. O risco de óbito nos primeiros 28 dias aumenta seis vezes em comparação às crianças com sífilis congênita sem sintomas (PAIXAO et al, 2023).…”

“…Brazilian Journal of Implantology and Health Sciences Volume 6, Issue 5 (2024), Page 813-823.¹Teste de Qui-quadrado de independência Legenda: n -frequência absoluta; N -dados válidos; % -percentual; DP -Desvio-padrão neste ambulatório. A média anual de casos em estudos observacionais uni ou multicêntricos nos últimos cinco anos na literatura foi de 4568(PAIXAO et al, 2023;…”

Congenital Syphilis: A Re-Emerging but Preventable Infection

“…Nevertheless, simple, cost-effective antenatal screening and treatment of infected pregnant women could prevent and ideally eliminate CS. Despite the availability of screening tools, affordable treatment options, and the integration of prevention programs into antenatal care in many countries, CS persists as a public health challenge, with increasing rates observed in many regions [ 6 , 7 ]. Timely pre- and perinatal screening, followed by the appropriate treatment of maternal syphilis infection with penicillin, is crucial to preventing the development of CS [ 8 ].…”

Congenital Syphilis—An Illustrative Review

“…Globally, perinatal syphilis is the second leading cause of stillbirths, and is associated with significant morbidity and mortality among affected newborns with congenital syphilis [ 3 ]. Although some countries such as Cuba and Thailand have successfully eliminated congenital syphilis, the rates are rising in many other countries [ 4 , 5 ]. Timely pre- and perinatal screening followed by adequate treatment of maternal syphilis infection using penicillin can prevent the development of congenital syphilis [ 6 ].…”