Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Medeiros, Joelma Alexandra Ruberti; Yamamura, Mellina; Silva, Zilda Pereira da; Domingues, Carmen Silvia Bruniera; Waldman, Eliseu Alves; Chiaravalloti-Neto, Francisco

doi:10.1038/s41598-021-04530-y

Cited by 12 publications

(10 citation statements)

References 38 publications

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“…Our analysis corroborates studies that show a relationship between the prevalence of syphilis and municipalities with higher demographic densities, because they show social and health determinants that enable the dissemination of the infection and, despite offering a wider health care service, it maintains social disparities and the populations’ difficulties to access the services [ 5 , 45 ].…”

Section: Discussionsupporting

confidence: 88%

Gestational and congenital syphilis across the international border in Brazil

Lannoy

Santos²,

Coelho³

et al. 2022

PLoS ONE

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Background Brazil lacks data from syphilis in its border areas. We aimed to describe the spatial and temporal distribution of acquired syphilis (AS), in pregnancy (SP) and congenital syphilis (CS) in Brazilian municipalities in the arches border contexts. Methods An ecological, cross-sectional study was conducted from 2010 to 2020. The study was based on the cases of syphilis available in the Notifiable Diseases Information System (SINAN), and on the Primary Health Care Information System. The detection rates of AS and SP, and the incidence of CS were estimated, and the time series was analyzed. Data between the border arches were compared. Results In 2020, data showed 7,603 cases of AS (detection rate 64.8/100,000 inhabitants), 3,960 cases of SP (detection rate of 21.6/1,000 live births) and 836 cases of CS (incidence of 4.6/1,000 live births) in the border region. Between 2010 and 2020, the mean annual increase of detection rate of SP was 53.4% in Brazil, 48.0% in the border region, 59.6% in the North Arch, 28.8% in the Central and 67.2% in the South. Annual variation on the incidence of CS for the same period was 31.0% in Brazil 38.4% at the border, in the North and South Arcs 18.3% and 65.7% respectively. The Central Arch showed an increase only between 2010 and 2018 (62.7%). A total of 427 (72.6%) municipalities has primary health care coverage ≥ 95% of the population. In 2019, 538 (91.8%) municipalities reported using rapid tests for syphilis, which decreased to 492 (84%) in 2020. In 2019, 441 (75.3%) municipalities reported administering penicillin, and 422 (72%) in 2020. Conclusion Our data show syphilis reman problem at the Brazilian border, rates in pregnant are high. It was observed a reduction in the detection rates, SP and the incidence of CS between 2018 and 2020. Syphilis should be included on the agenda of all management levels, aiming at expanding access and quality care.

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Section: Discussionsupporting

confidence: 88%

Gestational and congenital syphilis across the international border in Brazil

Lannoy

Santos²,

Coelho³

et al. 2022

PLoS ONE

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“…Potential factors that have likely contributed to increasing infectious syphilis cases and the re-emergence of congenital syphilis in higher income countries include an increase in high-risk sexual activities (multiple partners, overlapping relationships, sexual gender fluidity, drugs, alcohol and chemsex), increased travel and migration [17,19,21,22 ▪▪ ,23], factors that limit access to antenatal care (social and economic changes, closure of sexual health clinics, COVID-19, income loss and increased numbers of marginalized young women) and limited awareness and education amongst mothers and maternity services [8 ▪▪ ,16 ▪ ,17,19,21,22 ▪▪ ,23,24,25 ▪ ].…”

Section: Epidemiologymentioning

confidence: 99%

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Thean¹,

Moore²,

Nourse³

2022

Current Opinion in Infectious Diseases

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Purpose of reviewIn light of alarming increases in the incidence of congenital syphilis in many middle and higher income countries across the globe, this review summarizes recent changes in the epidemiology of syphilis, highlights recommended changes to testing in pregnancy and provides an update for the management of syphilis infection in pregnancy (SIP) and of the infant born to a mother with SIP.Recent findingsThe re-emergence of congenital syphilis is a result of increasing infectious syphilis in women of childbearing age, which is in turn a result of increasing syphilis in the general population particularly in Indigenous and marginalized populations. Potential reasons for the increase include changing sexual practices and increased travel and migration, as well as factors that limit healthcare access, particularly access to antenatal care and limited awareness and education amongst mothers and maternity services. A single antenatal test for syphilis is insufficient; more frequent testing in pregnancy is necessary even for women deemed to be low risk. The management of SIP and of the newborn is complex and guidelines should be readily available with clear recommendations.SummaryCongenital syphilis is preventable. The current crisis calls for a global and national multipronged, co-ordinated approach involving public health and hospital systems which includes education of individuals and healthcare workers, availability of updated guidelines for prevention and treatment, prioritization of antenatal testing, assurance of accessible and prompt treatment and appropriate assessment and follow-up of infants.

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“…The present study identified spatial clusters of municipalities with high rates of CS and SiP in Brazil. Between 2001 and 2017, almost all regions and microregions of the country reported a higher intensity of CS and SiP infections [ 47 , 54 , 57 – 62 ]. However, in most of Brazil’s microregions, there are few studies of these regions that do not highlight these areas as priority for a syphilis surveillance study.…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal distribution analysis of syphilis in Brazil: Cases of congenital and syphilis in pregnant women from 2001–2017

Silva

Leony²,

Souza³

et al. 2022

PLoS ONE

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In Brazil, the notification of congenital (CS) and syphilis in pregnant women (SiP) is compulsory. Notification data provided by the Ministry of Health in combination with the mapping of vulnerable geographic areas is essential to forecasting possible outbreaks and more effectively combating infection through monitoring. We aim to evaluate the spatiotemporal distribution and epidemiological aspects of reported cases of CS and SiP in Brazil. A retrospective ecological study was carried out using secondary surveillance data obtained from the Brazilian National Notifiable Diseases Information System (SINAN) database, considering all reported cases of CS and SiP between 2001 to 2017. Epidemiological characteristics and time trends were analyzed using joinpoint regression models and spatial distribution, considering microregions or states/macroregions as units of analysis. A total of 188,630 (359/100,000 birth lives) CS and 235,895 of SiP (6.3/100,000 inhabitants) were reported during the period studied. In general, the epidemiologic profile of Brazil indicates most reported CS cases occurred in "mixed-race" newborns who were diagnosed within seven days of birth and whose mothers had received prenatal care, but the epidemiologic profile varies by Brazilian macroregion. Regarding SiP, most cases were among women who self-reported ‘mixed-race’, were aged 20–39 years, had up to eight years of formal education and were diagnosed with primary or latent syphilis. Approximately 549 (98.4%) and 558 (100%) microregions reported at least one case of CS and SiP, respectively. From 2012 to 2016, CS cases increased significantly in almost all Brazilian states, most notably in the South, Southeast, and Central-West macroregions, from 2001–2017 and the relative risk (RR) of SiP increased around 400% (RR: 1,00 to 445,50). Considering the epidemiological scenario of the infection in Brazil, it is necessary to enhance preventive, control and eradication measures.

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Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil

Cited by 12 publications

References 38 publications

Gestational and congenital syphilis across the international border in Brazil

Gestational and congenital syphilis across the international border in Brazil

New trends in congenital syphilis: epidemiology, testing in pregnancy, and management

Spatiotemporal distribution analysis of syphilis in Brazil: Cases of congenital and syphilis in pregnant women from 2001–2017

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