Abstract
Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan. Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease). The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals.
Highlights
Congenital syphilis (CS) has reemerged in China as a common, preventable cause of stillbirth, neonatal death, low birth weight, and irreversible congenital malformations [1,2,3,4]
The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals
Syphilis is associated with other adverse outcomes, this study focused on measuring congenital syphilis (CS) cases because of the availability of robust data and a direct connection to National Syphilis Prevention and Control Plan (NSCP) goals [1,2,3,4]
Summary
Congenital syphilis (CS) has reemerged in China as a common, preventable cause of stillbirth, neonatal death, low birth weight, and irreversible congenital malformations [1,2,3,4]. In response to the resurgent syphilis epidemic, the Chinese Ministry of Health recently announced a comprehensive 10-y National Syphilis Prevention and Control Plan (NSCP). 1.5 million pregnant women are infected with syphilis, a bacterial infection that is usually transmitted during sexual contact but that can pass from a mother to her unborn child In many of these women, the disease is detected through routine antenatal testing and is successfully treated with penicillin. Among those women who are not treated, about half experience adverse outcomes—the death of their baby during early or late pregnancy (fetal death and stillbirth, respectively) or soon after birth (neonatal death), or the birth of an infected baby. Congenital syphilis is simple and cheap to eliminate—a few injections of penicillin can clear the infection in a pregnant woman, and screening all pregnant women for syphilis is feasible even in low-resource settings
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