Abstract
The increasing rates of maternal and congenital syphilis (CS) infections are public health concerns and need further investigation in order to provide better assistance in epidemiological surveillance and new strategies for the assistance and prevention of CS. In December 2011, the Brazilian Ministry of Health (BMH) implemented ordinance number 3.242, reinforced in 2012 by ordinance number 77, aiming to improve the quality of the syphilis diagnosis system using rapid tests. Here, we evaluate the incidence, lethality, and possible factors associated with CS in Salvador, Bahia, in the pre-resolution period (2007 to 2011) and post-resolution (2012 to 2016). An observational, ecological time-series study is conducted using secondary data collected from the National Notifiable Diseases Information System (SINAN). Linear regression analysis to estimate increases or reductions in the mean incidence over time is also performed. A total of 5470 CS cases are analyzed. The incidence ranges from 2.1 cases per 1000 live births in 2007 to 17.1 cases per 1000 live births in 2019, showing a progressive increase in incidence over the years and reduction of lethality in the post-resolution period. The number of CS cases reported prior to the implementation of the ordinances (2007–2011) does not reveal a significant increase in the incidence. However, in the post-ordinances period (2012–2019), there is an average increase of the number of CS cases by three times over the years, with an average increase of 1.8 new cases annually. Our findings highlight the importance of diagnosis and support information in strategies for CS prevention. Furthermore, these data show a positive impact of resolutions on the diagnosis and evolution of the disease.
Highlights
Our study describes the epidemiological profile of Congenital syphilis (CS) before and after the implementation of the Brazilian Ministry of Health ordinances related to maternal diagnostics
Our findings show a high incidence of CS compared to other regions of Brazil during the same period [13]
The implementation of the Brazilian Ministry of Health (BMH) ordinances had a positive impact on the diagnosis of maternal syphilis, adherence of pregnant women to attending antenatal care, and reductions in the lethality rates of CS
Summary
Mother-to-child transmission of syphilis has been considered a global public health burden since the 15th century, and approximately 1.5% of pregnant women (more than two million) develop clinical syphilis every year worldwide [1,2]. The absence of adequate treatment of pregnant women diagnosed with syphilis can cause spontaneous abortion, stillbirth, and early infant death; about 80% of affected pregnancies result in adverse outcomes [3,4]. Congenital syphilis (CS) is a consequence of the hematogenous dissemination of Treponema pallidum through the placenta from infected untreated or inappropriately treated pregnant women [5]. In the early stages of the disease, pregnant women are more
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