48 Congenital Syphilis in Canada: Findings of a Canadian Paediatric Surveillance Program Study

Abstract

Abstract Background Since 2015, the incidence of congenital syphilis (CS) in Canada has increased significantly. Vertical transmission of syphilis can be prevented through timely treatment of infected pregnant persons; however, difficulty engaging in prenatal care can preclude diagnosis, and consequently treatment. Canadian data on sociobehavioural risk factors associated with poor engagement in prenatal care is limited, yet needed to inform prevention efforts. Objectives Our primary objective is to identify sociobehavioural risk factors of mothers with infants affected by syphilis, as well as describe the screening and treatment they receive. Our secondary objective is to describe the presentation and management of affected infants in Canada. Design/Methods Cases of confirmed and probable CS were elicited from paediatricians through the Canadian Paediatric Surveillance Program between June 2021 and October 2022. Survey responses were analyzed using descriptive statistics. Results In total, 143 cases were reported: 78% originated from the prairies (Alberta n=39, Saskatchewan n=50, Manitoba n=23) and 34% resided rurally. The median age was 27 years (range 17-39). Among the 143 women, 94 (66%) reported substance use, 42 (29%) child protection involvement with a previous child, and 25 (17%) housing insecurity; however, “unknown” responses were frequent for many variables. Of those reporting substance use, methamphetamines (n=46/94, 49%) and opioids (n=34/94, 36%), were the most common. Most women (n=73/143, 51%) had no known sexually transmitted co-infection, but among those who did, chlamydia was the most common (n=38/70, 54%). Only 22% (n=32/143) reported at least one prenatal visit per trimester. Of the 85/143 mothers known to have a positive syphilis screen, 22% (n=19/85) did not receive treatment. Of the 28 cases where specific barriers to accessing prenatal care were reported, 8 reported substance use, 6 reported housing insecurity, and 6 reported attitudinal barriers. Most affected infants had no physical exam findings of CS (n=83/143, 58%), but among those who did, rash and hepatomegaly were the most common findings (n=17/143, 12% and n=15/143, 11% respectively). Of the 136 with long bone x-rays completed, 70% (n=95) were normal. Most cases (138/143, 96%) were identified within the first month of life, and 89% (n=127/143) began antibiotic treatment within a week of life. Conclusion Substance use during pregnancy is common in mothers of children with CS; however, the presence of other sociobehavioural risk factors is often not known by reporting paediatricians. Most affected infants are asymptomatic but are diagnosed and treated early. Findings will inform public health strategies for preventing CS and combatting the current epidemic.