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

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Abstract

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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Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016

Jane Rowley, Stephen Vander Hoorn, Eline Korenromp … (2019)

Abstract Objective To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15–49 years, in 2016. Methods For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. Findings For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3–4.5); gonorrhoea 0.9% (95% UI: 0.7–1.1); trichomoniasis 5.3% (95% UI:4.0–7.2); and syphilis 0.5% (95% UI: 0.4–0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9–3.7); gonorrhoea 0.7% (95% UI: 0.5–1.1); trichomoniasis 0.6% (95% UI: 0.4–0.9); and syphilis 0.5% (95% UI: 0.4–0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1–165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4–231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5–7.1 million) syphilis cases. Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016–2021.

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Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012

Eline Korenromp, Jane Rowley, Monica Alonso … (2019)

Background In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. Methods Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. Results The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57–0.81%) resulting in a global CS rate of 473 (385–561) per 100,000 live births and 661,000 (538,000–784,000) total CS cases, including 355,000 (290,000–419,000) adverse birth outcomes (ABO) and 306,000 (249,000–363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs– 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63–0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000–432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. Conclusions Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.

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Syphilis

Rosanna Peeling, Adele Benzaken, Justin D. Radolf … (2017)

Treponema pallidum subspecies pallidum ( T. pallidum ) causes syphilis via sexual exposure or vertical transmission during pregnancy . T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochetes and often imitate those of other diseases. The spirochete has a long latent period during which patients have no signs or symptoms, but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement is needed to ensure that syphilis is given high priority on the global health agenda. More investment in research is needed on the interaction between HIV and syphilis in MSM, as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

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Author and article information

Contributors

Ângelo Antônio Oliveira Silva: Role: Formal analysisRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Leonardo Maia Leony: Role: Writing – original draftRole: Writing – review & editing

Wayner Vieira de Souza: Role: InvestigationRole: MethodologyRole: Writing – review & editing

Natália Erdens Maron Freitas: Role: Writing – original draftRole: Writing – review & editing

Ramona Tavares Daltro: Role: VisualizationRole: Writing – original draft

Emily Ferreira Santos: Role: InvestigationRole: Writing – original draft

Larissa de Carvalho Medrado Vasconcelos: Role: MethodologyRole: Writing – original draft

Maria Fernanda Rios Grassi: Role: Writing – review & editing

Carlos Gustavo Regis-Silva: Role: Formal analysisRole: InvestigationRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Fred Luciano Neves Santos:

ORCID: https://orcid.org/0000-0002-3944-0818

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Antonio Simone Laganà: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 6 October 2022

Publication date Collection: 2022

Volume: 17

Issue: 10

Electronic Location Identifier: e0275731

Affiliations

[1 ] Advanced Public Health laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador, Bahia, Brazil

[2 ] Salvador University (UNIFACS), Salvador, Bahia, Brazil

[3 ] Department of Public Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation (Fiocruz-PE), Recife, Pernambuco, Brazil

[4 ] Bahiana School of Medicine and Public Health (EBMSP), Salvador, Bahia, Brazil

[5 ] Integrated Translational Program in Chagas Disease from Fiocruz (Fio-Chagas), Oswaldo Cruz Foundation (Fiocruz-RJ), Rio de Janeiro, Rio de Janeiro, Brazil

University of Palermo: Universita degli Studi di Palermo, ITALY

Author notes

Competing Interests: The authors declare that they have no competing interests.

* E-mail: fred.santos@ 123456fiocruz.br

Author information

Fred Luciano Neves Santos https://orcid.org/0000-0002-3944-0818

Article

Publisher ID: PONE-D-21-31051

DOI: 10.1371/journal.pone.0275731

PMC ID: 9536537

PubMed ID: 36201505

SO-VID: 53b7c1fb-b101-4d8a-9da8-6b79b6e3cb6f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 26 September 2021

Date accepted : 22 September 2022

Page count

Figures: 7, Tables: 0, Pages: 19

Funding

Funded by: Coordination of Superior Level Staff Improvement-Brazil (CAPES)

Award ID: Finance Code 001

Award Recipient :

ORCID: https://orcid.org/0000-0002-3944-0818

Fred Luciano Neves Santos

Funded by: Research Support Foundation of the State of Bahia (Fundação de Amparo à Pesquisa do Estado da Bahia - FAPESB)

Award ID: BOL0261/2018

Award Recipient : Ângelo Antônio Oliveira Silva

Funded by: Research Support Foundation of the State of Bahia (Fundação de Amparo à Pesquisa do Estado da Bahia - FAPESB)

Award ID: BOL0932/20

Award Recipient : Larissa de Carvalho Medrado Vasconcelos

Funded by: Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq)

Award ID: 306222/2013-2

Award Recipient : Wayner Vieira de Souza

Funded by: Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq)

Award ID: 304811/2017-3

Award Recipient : Maria Fernanda Rios Grassi

Funded by: Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq)

Award ID: 309263/2020-4

Award Recipient :

ORCID: https://orcid.org/0000-0002-3944-0818

Fred Luciano Neves Santos

This work was supported by the Coordination of Superior Level Staff Improvement-Brazil (CAPES; Finance Code 001) and the Research Support Foundation of the State of Bahia (Fundação de Amparo à Pesquisa do Estado da Bahia - FAPESB; BOL0261/2018 and BOL0932/20). Wayner Vieira de Souza, Maria Fernanda R. Grassi, and Fred Luciano N. Santos are research fellows of the Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq; process no. 306222/2013-2, 304811/2017-3, and 309263/2020-4, respectively). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

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Most cited references 53

Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016

Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012

Syphilis

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