Sífilis congênita no município de São Gonçalo: Evolução temporal 2007-2018

Abstract

Congenital syphilis persists as a frequent disease in Brazil and especially in the metropolitan regions of the state of Rio de Janeiro (ERJ). Objective: To analyze the temporal distribution and epidemiological characteristics of congenital syphilis (SC) in the most populous municipality in metropolitan region II of the ERJ, Sao Goncalo, from 2007 to 2018. Methods: Time series study, with secondary data from the Information System of Notifiable Diseases (SINAN) and the Live Birth Information System (SINASC). The population base was composed of all live births, abortions, and stillbirths. The cases were described according to sociodemographic and specific characteristics of the disease. The annual incidence of SC was estimated, globally and according to the variables of maternal age and education, skin color and prenatal care. For the analysis of the time series, the annual percentage variation of incidence rates was calculated, according to the same variables, using the Joinpoint Regression program. The completeness of SINAN was also evaluated, accounting for the percentage of information ignored according to the Romero and Cunha score. Results: 2430 cases of SC were identified from 2007 to 2018. Women were predominantly adults aged 20 to 34 years, followed by adolescents (30%), with low education. About 70% declared themselves to be brown, and the vast majority performed prenatal care. There were variable percentages of incompleteness of maternal variables, with the worst completion being that of schooling, which reached almost 80% at the beginning of the period; regarding the newborn's data, the worst was the quantity of CSF VDRL, which reached 100%. An improvement in completeness stood out in the last years studied. As for the conceptuses, despite the majority being asymptomatic, there were 36 neonatal deaths and 62 stillbirths, concentrated from 2012 to 2018. The investigation protocol of newborns failed in relation to the examination of the CSF and the X-ray of long bones. Incidence rates were higher among adolescent women (90.6 in 2018), black (87.6 in 2018) and brown (51.1 in 2018), and among those with low education (122.8 in 2018). Although smaller in those who did PN, they were still high. As for the temporal evolution,the incidence of SC increased from 6.3 in 2007 to 41.6 per thousand LB in 2018, and the increase was concentrated in the period from 2010 to 2015, about 50% annually (CI: 27.6- 79.1). The trend according to sociodemographic variables confirmed the inequalities: the biggest increase was among adolescents; black and with low education. The annual increase was similar between those who did and those who did not do PN. Conclusion: In addition to improvements in access and adequacy of prenatal care, it is necessary to control syphilis acquired especially in the most vulnerable population, in addition to training professionals involved in prenatal care and during childbirth and birth