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Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modelling study

N Saman Wijesooriya, Roger W Rochat, Mary L Kamb and 4 more

The Lancet Global Health · 2016 · CC BY-NC-ND

Abstract

BACKGROUND: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis. METHODS: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on livebirths, antenatal care coverage, and syphilis testing, seropositivity, and treatment in antenatal care. For 2012 estimates, we used data collected between 2009 and 2012. We updated the 2008 estimates using data collected between 2000 and 2008, compared these with 2012 estimates using data collected between 2009 and 2012, and performed subanalyses to validate results. FINDINGS: In 2012, an estimated 930 000 maternal syphilis infections caused 350 000 adverse pregnancy outcomes including 143 000 early fetal deaths and stillbirths, 62 000 neonatal deaths, 44 000 preterm or low weight births, and 102 000 infected infants worldwide. Nearly 80% of adverse outcomes (274 000) occurred in women who received antenatal care at least once. Comparing the updated 2008 estimates with the 2012 estimates, maternal syphilis decreased by 38% (from 1 488 394 cases in 2008 to 927 936 cases in 2012) and congenital syphilis decreased by 39% (from 576 784 to 350 915). India represented 65% of the decrease. Analysis excluding India still showed an 18% decrease in maternal and congenital cases of syphilis worldwide. INTERPRETATION: Maternal and congenital syphilis decreased worldwide from 2008 to 2012, which suggests progress towards the elimination of mother-to-child transmission of syphilis. Nonetheless, maternal syphilis caused substantial adverse pregnancy outcomes, even in women receiving antenatal care. Improved access to quality antenatal care, including syphilis testing and treatment, and robust data are all important for achieving the elimination of mother-to-child transmission of syphilis. FUNDING: The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction in WHO, and the US Centers for Disease Control and Prevention.

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References 38

1.
Fiumara NJ. Syphilis among mothers and children. Ann N Y Acad Sci 1988; 549: 187–92.
Not in our library10.1111/j.1749-6632.1988.tb23971.x
2.
Chakraborty R, Luck S. Syphilis is on the increase: the implications for child health. Arch Dis Child 2008; 93: 105–09.
Not in our library10.1136/adc.2006.103515
3.
Gomez GB, Kamb ML, Newman LM, Mark J, Broutet N, Hawkes SJ. Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ 2013; 91: 217–26.
Not in our library10.2471/blt.12.107623
4.
Woods CR. Congenital syphilis-persisting pestilence. Pediatr Infect Dis J 2009; 28: 536–37
Not in our library10.1097/inf.0b013e3181ac8a69
5.
Zenker PN, Rolfs RT. Treatment of syphilis, 1989. Rev Infect Dis 1990; 12 (suppl 6): S590–609.
Not in our library10.1093/clinids/12.supplement_6.s590
6.
Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality · 2011
No notice
7.
WHO. The Global Elimination of Congenital syphilis: rationale and strategy for action. Geneva: World Health Organization, 2007.
Not in our library
8.
Schackman BR, Neukermans CP, Fontain SN, Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti. PLoS Med 2007; 4: e183.
Not in our library10.1371/journal.pmed.0040183
9.
World Bank. World development report 1993: Investing in health. New York: World Bank, 1993.
Not in our library
10.
WHO. Investment case for eliminating mother-to-child transmission of syphilis: Promoting better maternal and child health and stronger health systems. Geneva: World Health Organization, 2012.
Not in our library
11.
Schmid GP, Stoner BP, Hawkes S, Broutet N. The need and plan for global elimination of congenital syphilis. Sex Transm Dis 2007; 34 (suppl): S5–10.
Not in our library10.1097/01.olq.0000261456.09797.1b
12.
WHO. Methods for surveillance and monitoring of congenital syphilis elimination within existing systems. Geneva: World Health Organization, 2011.
Not in our library
13.
Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data · 2013
No notice
14.
United Nations. The World Population Prospects -the 2010 revision. http://unstats.un.org/unsd/mdg/Resources/Static/Data/MDGRegionCodes_200611.xls (accessed June 28, 2011).
Not in our library
15.
Cousens S, Blencowe H, Stanton C, National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 2011; 377: 1319–30.
Not in our library10.1016/s0140-6736(10)62310-0
16.
WHO. Antenatal care coverage: at least one visit (%). http://apps.who.int/gho/data/node.main.492?lang=en (accessed Oct 16, 2013).
Not in our library
17.
Antenatal syphilis screening using point-of-care testing in Sub-Saharan African countries: a cost-effectiveness analysis. · 2013
Not checked
18.
Republic of Senegal National Council for the Fight Against AIDS Ministry of Health and Medical Prevention Division of the Fight Against AIDS and STIs. 2009 Sentinel surveillance of HIV and syphilis in pregnant women in Senegal. Epidemiological Bulletin No. 14; Dakar, Senegal.
Not in our library
19.
Strasser S, Bitarakwate E, Gill M, Introduction of rapid syphilis testing within prevention of mother-to-child transmission of HIV programs in Uganda and Zambia: a field acceptability and feasibility study. J Acquir Immune Defic Syndr 2012; 61: e40–6.
Not in our library10.1097/qai.0b013e318267bc94
20.
Caddy SC, Lee BE, Sutherland K, Pregnancy and neonatal outcomes of women with reactive syphilis serology in Alberta, 2002 to 2006. J Obstet Gynaecol Can 2011; 33: 453–59.
Not in our library10.1016/s1701-2163(16)34878-2
21.
Sampedro A, Mazuelas P, Rodriguez-Granger J, Torres E, Puertas A, Navarro JM. Serological markers in immigrant and Spanish pregnant women in Granada. Enferm Infecc Microbiol Clin 2010; 28: 694–97 (in Spanish).
Not in our library10.1016/j.eimc.2010.04.007
22.
Kwan KS, Giele CM, Combs B, Mak DB. Improvement in antenatal testing for sexually transmissible infections and blood-borne viruses in Western Australian hospitals, 2007 to 2010. Sex Health 2012; 9: 349–54.
Not in our library10.1071/sh11151
23.
Cho YH, Kim HO, Lee JB, Lee MG. Syphilis prevalence has rapidly decreased in South Korea. Sex Transm Infect 2003; 79: 323–24.
Not in our library10.1136/sti.79.4.323
24.
Cliffe SJ, Tabrizi S, Sullivan EA, and the Pacific Islands Second Generation HIV Surveillance Group. Chlamydia in the Pacific region, the silent epidemic. Sex Transm Dis 2008; 35: 801–06.
Not in our library10.1097/olq.0b013e318175d885
25.
Murray CJ, Ezzati M, Flaxman AD, GBD 2010: design, definitions, and metrics. Lancet 2012; 380: 2063–66.
Not in our library10.1016/s0140-6736(12)61899-6
26.
Ham DC, Lin C, Newman L, Wijesooriya NS, Kamb M. Improving global estimates of syphilis in pregnancy by diagnostic test type: A systematic review and meta-analysis. Int J Gynaecol Obstet 2015; 130 (suppl 1): S10–14.
Not in our library10.1016/j.ijgo.2015.04.012
27.
Flenady V, Koopmans L, Middleton P, Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011; 377: 1331–40.
Not in our library10.1016/s0140-6736(10)62233-7
28.
Lawn JE, Blencowe H, Pattinson R,, and The Lancets Stillbirths Series steering committee. Stillbirths: Where? When? Why? How to make the data count? Lancet 2011; 377: 1448–63.
Not in our library10.1016/s0140-6736(10)62187-3
29.
World Bank. Country and Lending Groups. http://data.worldbank.org/about/country-and-lending-groups (accessed May 14, 2014).
Not in our library
30.
WHO. Global guidance on criteria and processes for validation: elimination of mother-to-child transmission (the elimination of mother-to-child transmission) of HIV and syphilis. Geneva: World Health Organization, 2014.
Not in our library
31.
Joint United Nations Programme on HIV/AIDS. Global AIDS response progress reporting 2014: construction of core indicators for monitoring the 2011 UN political declaration of HIV /AIDS. Geneva: Joint United Nations Programme on HIV/AIDS, 2014.
Not in our library
32.
Hawkes S, Matin N, Broutet N, Low N. Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011; 11: 684–91.
Not in our library10.1016/s1473-3099(11)70104-9
33.
Sethi S, Sharma K, Dhaliwal LK, Banga SS, Sharma M. Declining trends in syphilis prevalence among antenatal women in northern India: a 10-year analysis from a tertiary healthcare centre. Sex Transm Infect 2007; 83: 592.
Not in our library10.1136/sti.2007.025551
34.
Arora P, Nagelkerke NJ, Moineddin R, Bhattacharya M, Jha P. Female sex work interventions and changes in HIV and syphilis infection risks from 2003 to 2008 in India: a repeated cross-sectional study. BMJ Open 2013; 3:
Not in our library10.1136/bmjopen-2013-002724
35.
Mehta KD, Antala S, Mistry M, Goswami Y. Seropositivity of hepatitis B, hepatitis C, syphilis, and HIV in antenatal women in India. J Infect Dev Ctries 2013; 7: 832–37
Not in our library10.3855/jidc.2764
36.
Bala M, Singh V, Muralidhar S, Ramesh V. Assessment of reactivity of three treponemal tests in non-treponemal non-reactive cases from sexually transmitted diseases clinic, antenatal clinic, integrated counselling and testing centre, other different outdoor patient departments/indoor patients of a tertiary care centre and peripheral health clinic attendees. Indian J Med Microbiol 2013; 31: 275–79.
Not in our library10.4103/0255-0857.115638
37.
Shah SA, Kristensen S, Memon MA, Prevalence of syphilis among antenatal clinic attendees in Karachi: imperative to begin universal screening in Pakistan. J Pak Med Assoc 2011; 61: 993–97.
Not in our library
38.
US Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012. Atlanta: Centers for Disease Control and Prevention, 2013.
Not in our library

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