Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil (original) (raw)

We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development. Syphilis is a disease whose etiological agent is Treponema pallidum. With the discovery of penicillin, the disease was expected to be eliminated. Nevertheless, the number of infected adults, pregnant women, and children has increased significantly 1,2. Pregnant women with syphilis who do not receive the correct treatment may experience fetal and neonatal deaths, preterm births, and babies with low birth weight. Live births (LB) can suffer from the clinical effects and consequences of T. pallidum infections. The factors that contribute to the acquisition of syphilis by the women are related to socioeconomic and cultural aspects, such as gender inequalities, low education level, adolescent early sexual activity, and drug use. These factors are complemented by certain biological characteristics of women, such as genital epithelial disruptions and the difficulty to identify the signs and symptoms of syphilis 3. To manage this scenario, it is necessary for women to have access to health care and adequate treatment; this highlights the role of primary health care (PHC) to deal with the diagnosis, notification, surveillance, and treatment of syphilis. In 2006, the Pan American Health Organization and other organizations agreed on the targets for the elimination of congenital syphilis (CS) 4. However, even with the implementation of these initiatives, CS and syphilis in pregnant women (SPW) have remained increasingly serious public health problems 1,2. Korenromp et al. 5 estimated that in 2016, the global prevalence of SPW was 0.69% and the global occurrence of CS was 661,000 cases. Accordingly, 355,000 cases with adverse outcomes were estimated, with 143,000 early fetal deaths and stillbirths, and 61,000 neonatal deaths. They also estimated the occurrence of 41,000 and 109,000 preterm or lowbirth-weight births and children with clinical illnesses, respectively 5. To deal with this picture, the Pan American Health Organization recently developed a specific model for transmissible diseases, including acquired syphilis (AS), SPW, and CS, that articulates directly to the sustainable development goal number 3 of the 2030 Agenda 6. In Brazil, the detection rate of AS has increased significantly in all age groups, especially in those aged 20-29 years.