Prioritizing Congenital Syphilis Control in South China: A Decision Analytic Model to Inform Policy Implementation

Tan, Nicholas X.; Rydzak, Chara E.; Yang, Li; Vickerman, Peter; Yang, Bin; Peeling, Rosanna W.; Hawkes, Sarah; Chen, Xiang Sheng; Tucker, Joseph D.

doi:10.1371/journal.pmed.1001375

Cited by 12 publications

(11 citation statements)

References 37 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 Although the burden of adverse pregnancy outcomes has greatly improved, further efforts are required, as some infected cases can still go undetected and untreated. 27 Several women were neither diagnosed nor treated early enough during their pregnancy, and only 32.2% of infected women started treatment in the first or second trimester. 20 In China, 55.6% of women are diagnosed during pregnancy, with more than 40% remaining undetected and untreated until delivery and postpartum.…”

Section: Discussionmentioning

confidence: 99%

Intra‐couple discordance in preconception syphilis screening for both spouses: a national and population‐based survey in China, 2013–2018

Zhou

Ying-zhou

Wang

et al. 2021

BJOG

View full text Add to dashboard Cite

Objective The antenatal screening strategy remains inadequate for eliminating congenital syphilis. To further eliminate maternal fetal transmission, preconception syphilis screening is considered an option. In this study, we investigated syphilis seropositivity and intra-couple discordance among married couples planning a pregnancy in China to provide essential baseline evidence for preconception syphilis screening.Design Population-based survey.Setting National preconception registered data.Population Married Chinese couples planning conception within 6 months between 2013 and 2018.Methods Syphilis was screened using rapid plasma reagin (RPR); infection self-reporting and sociodemographic characteristics were collected through questionnaires and medical records, respectively. R 3.2.2 and ARCGIS 10.2 were used for statistical analyses and geographic mapping.Main outcome measures RPR seropositivity.Results Among 31 955 041 couples, 29 737 172 (93.06%) had complete RPR results for both spouses; of those, 0.62% (186 100) were seropositive, with dramatic intra-couple discordance, with 0.33% positivity in wives, 0.24% positivity in husbands and 0.05% positivity in both spouses. Across time, both seropositivity and intra-couple discordance remained stable. Seropositivity in different regions varied significantly, with provincial rates ranging geographically from Tibet (0.8%) to Hebei (0.2%) (P < 0.05). Economic level was an independent factor for this regional variation, with seropositivity increasing as gross domestic product income decreased (P < 0.05).Conclusions Intra-couple discordance in seropositivity for syphilis is notable among couples, with a considerable rate of pre-existing syphilis before pregnancy. Thus, screening both spouses during integrated preconception health care is recommended for further eliminating maternal-fetal transmission.

show abstract

Section: Discussionmentioning

confidence: 99%

Intra‐couple discordance in preconception syphilis screening for both spouses: a national and population‐based survey in China, 2013–2018

Zhou

Ying-zhou

Wang

et al. 2021

BJOG

View full text Add to dashboard Cite

show abstract

“…The 10-year National Syphilis Prevention and Control Plan, announced by the Ministry of Health in 2010, is a promising step forward with its emphasis on expanding syphilis testing coverage among pregnant women in urban and rural areas [45]. However, the screening and treatment coverage targets are too low to meet the goal of reducing congenital syphilis by 2020 [46]. A key element missing from the national plan is an emphasis on earlier antenatal screening.…”

Section: Discussionmentioning

confidence: 99%

Syphilis Screening among 27,150 Pregnant Women in South Chinese Rural Areas Using Point-of-Care Tests

et al. 2013

Self Cite

View full text Add to dashboard Cite

ObjectivesTo determine the prevalence and correlates of syphilis among pregnant women in rural areas of South China.MethodsPoint-of-care syphilis testing was provided at 71 health facilities in less developed, rural areas of Guangdong Province. Positive samples were confirmed at a local referral center by toluidine red unheated serum tests (TRUST) and Treponema pallidum particle agglutination (TPPA) tests.ResultsAltogether 27,150 pregnant women in rural Guangdong were screened for syphilis. 106 (0.39%) syphilis cases were diagnosed, of which 78 (73.6%) received treatment for syphilis. Multivariate analysis revealed that older pregnant women (31–35 years old, aOR 2.7, 95% CI 0.99–7.32; older than 35 years old, aOR 5.9, 95% CI 2.13–16.34) and those with a history of adverse pregnant outcomes (aOR 3.64, 95% CI 2.30–5.76) were more likely to be infected with syphilis.ConclusionsA high prevalence of syphilis exists among pregnant women living in rural areas of South China. Enhanced integration of syphilis screening with other routine women's health services (OB GYN, family planning) may be useful for controlling China's syphilis epidemic.

show abstract

“…high proportion of perinatal morbidity and mortality in underprivileged settings (13)(14)(15) and up to 50% of stillbirths in sub-Saharan Africa (15). The development of an effective syphilis vaccine could significantly curtail the spread of this infection.…”

mentioning

confidence: 99%

Evaluation of the Protective Ability of the Treponema pallidum subsp.pallidumTp0126 OmpW Homolog in the Rabbit Model of Syphilis

Haynes

Godornes

et al. 2019

Infect Immun

View full text Add to dashboard Cite

In silico analyses of Treponema pallidum subsp. pallidum genomes and predicted proteomes to search for homologs of known bacterial outer membrane proteins (OMPs) led to the identification of tp0126 as a gene encoding a putative member of the OmpW family of porins/virulence factors. Our previous investigations on the role of Tp0126 in T. pallidum biology and syphilis pathogenesis showed that Tp0126 is fully conserved among T. pallidum strains and that transcription of tp0126 is driven by 70 . These initial results pointed to a housekeeping function for this protein. We also demonstrated that a guanosine homopolymer of various lengths located between the Ϫ10 and Ϫ35 consensus sequences in the tp0126 promoter modulates transcription consistently with phase variation, a mechanism that we also previously described for other T. pallidum genes encoding putative OMPs/virulence factors and that is often employed as a strategy for immune evasion. Circular dichroism spectra of recombinant Tp0126 also supported its structural homology with OmpW. Here we further investigated the humoral and cellular responses to Tp0126 during experimental and natural syphilis and the ability of Tp0126 to confer protection against syphilis in immunized rabbits. B-cell epitope mapping showed that compared to sera from experimentally infected animals, immunizations enhanced humoral immunity to sequences located in the putative Tp0126 surface-exposed loops, while phagocytosis assays showed that postimmunization sera opsonized T. pallidum. Despite such promising results, no significant protection was seen following infectious challenge in immunized animals versus controls. Functional redundancy and phase variation might explain the lack of effectiveness of this vaccine candidate and/or design.

show abstract

Prioritizing Congenital Syphilis Control in South China: A Decision Analytic Model to Inform Policy Implementation

Abstract: Nicholas Tan and colleagues use a decision analytic model to quantify the impact of the ten-year national syphilis control plan in China and conclude that earlier and more extensive screening are also necessary for reaching policy goals.

Cited by 12 publications

References 37 publications

Intra‐couple discordance in preconception syphilis screening for both spouses: a national and population‐based survey in China, 2013–2018

Intra‐couple discordance in preconception syphilis screening for both spouses: a national and population‐based survey in China, 2013–2018

Syphilis Screening among 27,150 Pregnant Women in South Chinese Rural Areas Using Point-of-Care Tests

Evaluation of the Protective Ability of the Treponema pallidum subsp.pallidumTp0126 OmpW Homolog in the Rabbit Model of Syphilis

Contact Info

Product

Resources

About