Examining associations in congenital syphilis infection and socioeconomic factors between California’s small-to-medium and large metro counties

Fang, Juliet; Silva, Rona M.; Tancredi, Daniel J.; Pinkerton, Kent E.; Sankaran, Deepika

doi:10.1038/s41372-022-01445-y

Cited by 11 publications

(14 citation statements)

References 13 publications

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“…It is also important to highlight that CS was more common among live-born of, most socially vulnerable women, particularly those younger, single, black and mixed/brown (Pardas) mothers with fewer years of education [26]. It is well known that CS is a marker of quality of care during neonatal care, and our findings reinforce the inequity in this regard.…”

Section: Plos Medicinesupporting

confidence: 74%

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

et al. 2023

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Background Congenital syphilis (CS) is a major and avoidable cause of neonatal death worldwide. In this study, we aimed to estimate excess all-cause mortality in children under 5 years with CS compared to those without CS. Methods and findings In this population-based cohort study, we used linked, routinely collected data from Brazil from January 2011 to December 2017. Cox survival models were adjusted for maternal region of residence, maternal age, education, material status, self-declared race and newborn sex, and year of birth and stratified according to maternal treatment status, non-treponemal titers and presence of signs and symptoms at birth. Over 7 years, a total of 20 057 013 live-born children followed up (through linkage) to 5 years of age, 93 525 were registered with CS, and 2 476 died. The all-cause mortality rate in the CS group was 7·84/1 000 person-years compared with 2·92/1 000 person-years in children without CS, crude hazard ratio (HR) = 2·41 (95% CI 2·31 to 2·50). In the fully adjusted model, the highest under-five mortality risk was observed among children with CS from untreated mothers HR = 2·82 (95% CI 2·63 to 3·02), infants with non-treponemal titer higher than 1:64 HR = 8·87 (95% CI 7·70 to 10·22), and children with signs and symptoms at birth HR = 7·10 (95% CI 6·60 to 7·63). Among children registered with CS, CS was recorded as the underlying cause of death in 33% (495/1 496) of neonatal, 11% (85/770) of postneonatal, and 2·9% (6/210) of children 1 year of age. The main limitations of this study were the use of a secondary database without additional clinical information and the potential misclassification of exposure status. Conclusions This study showed an increased mortality risk among children with CS that goes beyond the first year of life. It also reinforces the importance of maternal treatment that infant non-treponemal titers and the presence of signs and symptoms of CS at birth are strongly associated with subsequent mortality. Trial registration Observational study.

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Section: Plos Medicinesupporting

confidence: 74%

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

et al. 2023

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“…Geographically, the American West and Southeast currently have the highest rates of PS syphilis as of 2020 (16.7 and 13.2 per 100 000, respectively), and while urban counties consistently report the highest incidence rates, rates among some rural jurisdictions are increasing, among women in particular . Dermatologists should be aware of local epidemiologic trends to guide their screening practice.…”

Section: Epidemiology and Risk Stratification For Screeningmentioning

confidence: 99%

Resurgence of Syphilis in the US—USPSTF Reaffirms Screening Guidelines

2022

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Since its modern-day nadir of 5979 cases per year, or 2.1 cases per 100 000 population, in 2001, primary and secondary (PS) syphilis incidence has rapidly increased. In 2019, 38 992 cases, or 11.9 cases per 100 000, were reported, more than a 5-fold increase. 1 The United States Preventive Services Task Force (USPSTF) currently "recommends screening for syphilis infection in persons who are at increased risk for infection (A recommendation)." 2 The recommendation applies to asymptomatic, nonpregnant adolescents and adults who have ever been sexually active and is based on findings that the benefits of screening outweigh the harms. Because dermatologists are among the frontline health care professionals in the fight against syphilis, the USPSTF recommendation, supported by an updated evidence report and systematic review, 3 presents an opportunity to update the dermatology community regarding recent trends in syphilis epidemiology, clinical presentation, testing, and treatment.

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“…In addition to behavioral and socioeconomic risk factors, insufficient prenatal screening has been implicated in rapidly rising CS rates ( 21 , 22 ). Until March 2023, Mississippi was one of only a few states not mandating syphilis screening for prospective mothers ( 23 , 24 ).…”

Section: Discussionmentioning

confidence: 99%

Spike in Congenital Syphilis, Mississippi, USA, 2016–2022

Staneva,

Hobbs,

Dobbs

2023

Emerg. Infect. Dis.

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In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (<37 weeks), and having very low birthweight (<1,500 g) than those without CS. Mean length of hospital stay (14.5 days vs. 3.8 days) and mean charges ($56,802 vs. $13,945) were also higher for infants with CS than for those without. To address escalation of CS, Mississippi should invest in comprehensive prenatal care and early treatment of vulnerable populations.

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Examining associations in congenital syphilis infection and socioeconomic factors between California’s small-to-medium and large metro counties

Cited by 11 publications

References 13 publications

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study

Resurgence of Syphilis in the US—USPSTF Reaffirms Screening Guidelines

Spike in Congenital Syphilis, Mississippi, USA, 2016–2022

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