Analysis of the Space and Time Distribution of Syphilis in Brazil: Cases of Acquired Syphilis From 2010-2018 and Congenital and Syphilis in Pregnant Women From 2001-2017

Abstract

Background. In Brazil, the notification of acquired syphilis (AS), congenital syphilis (CS) and syphilis in pregnant women (SiP) is compulsory. Notification data provided by the Ministry of Health (MoH) in combination with the mapping of vulnerable geographic areas is essential to forecasting possible outbreaks and more effectively combating infection through monitoring. We aim evaluated the space and time distribution of reported cases of CS and SiP in Brazil (2001 to 2017), as well as an estimation of cases of AS (2010 to 2018). Methods. 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 2002 to 2017, as well as MoH epidemiological bulletin data regarding cases of AS between 2010 to 2018. Epidemiological characteristics and time trends were analyzed using joinpoint regression models and spatial distribution (three-year moving averages), considering microregions or states/macroregions as units of analysis. Results. A total of 188,630 (5.4/100,000) CS, 235,895 SiP (6.3/100,000) and 479,731 cases of AS (27.4/100,000) were reported during the periods studied. The epidemiological profile of Brazil indicates most reported CS cases occurred among ‘mixed-race’ newborns who were diagnosed within seven days after birth and whose mothers had received prenatal care. 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. Overall, rates of AS rose around 400% from 2010 to 2018. Nearly all microregions reported at least one case of CS and SiP. From 2012 to 2016, CS cases increased significantly in almost all Brazilian states, most notably in the South, Southeast, and Central-West macroregions, from 2001-2018 and the relative risk of SiP increased around 4,000%. Conclusions. Considering the epidemiological scenario of the infection in Brazil, it is necessary to enhance preventive, control and eradication measures.