BACKGROUND:
Neonatal
infection with herpes simplex virus (HSV) is not a nationally reportable
disease; there have been few population-based measures of HSV-related infant
mortality. We describe infant death rates due to neonatal HSV as compared with
congenital syphilis (CS) and HIV, 2 reportable, perinatally transmitted
diseases, in New York City from 1981 to 2013.
METHODS:
We
identified neonatal HSV-, CS-, and HIV-related deaths using International
Classification of Diseases (ICD) codes listed on certificates of death or
stillbirth issued in New York City. Deaths were classified as HSV-related if
certificates listed (1) any HSV ICD-9/ICD-10 codes for deaths ≤42 days of age,
(2) any HSV ICD-9/ICD-10 codes and an ICD code for perinatal infection for
deaths at 43 to 365 days of age, or (3) an ICD-10 code for congenital HSV. CS-
and HIV-related deaths were those listing any ICD code for syphilis or HIV.
RESULTS:
There
were 34 deaths due to neonatal HSV (0.82 deaths per 100 000 live births), 38
from CS (0.92 per 100 000), and 262 from HIV (6.33 per 100 000). There were no
CS-related deaths after 1996, and only 1 HIV-related infant death after 2004.
The neonatal HSV-related death rate during the most recent decade (2004-2013)
was significantly higher than in previous years.
CONCLUSIONS:
The
increasing neonatal HSV-related death rate may reflect increases in neonatal
herpes incidence; an increasing number of pregnant women have never had HSV
type 1 and are therefore at risk of acquiring infection during pregnancy and
transmitting to their infant.
- 1Bureaus of Public Health Training.
- 2Vital Statistics, and.
- 3Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene, New York, New York; and Division of Sexually Transmitted Disease Prevention, National Center for HIV, Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia jschilli@health.nyc.gov.
- Pediatrics. 2016 Mar 1. pii: peds.2015-2387.
The number of CS cases declined in the United States during
2008–2012 from 446 to 334 cases (10.5 to 8.4 cases per 100,000 live births),
reflecting trends in rates of P&S syphilis among women, which decreased
from 1.5 to 0.9 cases per 100,000 women (Figure). During this period, all regions of
the United States experienced a decrease in CS rates except the Midwest, where
the rate increased 62% (from 4.2 to 6.8 cases per 100,000 live births) (Table 1).† The
increase in CS in the Midwest was attributed primarily to increases in CS rates
in Illinois and Ohio, which occurred 1–2 years after observed increases in
P&S syphilis among women in these states (6). Substantial declines
occurred in all other regions (51% in the Northeast, 46% in the West, and 16%
in the South), leading to an overall national decline in CS rates to the lowest
level since 2005.
Racial disparities in CS rates between non-Hispanic blacks
(blacks) and non-Hispanic whites (whites) increased during 2008–2012, because
relative decreases in rates of CS were greater among whites (21%) than blacks
(11%). As has been observed previously, the majority of CS cases (57%) in 2012
continued to be among infants whose mothers were black (2).
During 2012–2014, the number of reported CS cases in the
United States increased from 334 to 458, representing an increase in rate from
8.4 to 11.6 cases per 100,000 live births. As has been observed with earlier CS
trends (2), the increase in CS rates during
2012–2014 reflected an increase in the rate of P&S syphilis among women
(22.2% increase, from 0.9 to 1.1 cases per 100,000 women) during the same
period (Figure). Increases in CS rates occurred in all
regions but were greatest in the West, where the rate more than doubled (from
5.5 to 12.8 cases per 100,000 live births) (Table 1). In total, 19 states reported an
increase in number of CS cases and CS rates during 2012–2014, including California
(from 35 to 99 cases; 6.9 to 20.0 cases per 100,000 live births), Florida (from
37 to 47 cases; 17.4 to 21.8 per 100,000 live births), Louisiana (from 33 to 46
cases; 52.7 to 72.8 per 100,000 live births), Michigan (from 7 to 15 cases; 6.2
to 13.2 per 100,000 live births), and New York (from 8 to 22 cases; 3.3 to 9.3
per 100,000 live births). Although there was an overall national increase, the
number of CS cases and CS rates decreased in multiple large states, including
Texas (from 78 to 74 cases; 20.4 to 19.1 per 100,000 live births) and Ohio
(from 19 to 15 cases; 13.7 to 10.8 per 100,000 live births).
All racial/ethnic groups experienced an increase in case
counts and rates of CS during 2012–2014 (Table 1). The CS rate among whites, blacks,
and Hispanics increased 61%, 19%, and 39%, respectively. In 2014, the rate
among blacks remained approximately 10 times the rate among whites and three
times the rate among Hispanics.
Via: http://ht.ly/UzWKi By: https://twitter.com/cdcmmwr
This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes.
Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01).
Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.
Read more at: http://ht.ly/S9HDU
By: Hebmuller MG1, Fiori HH1, Lago EG1.
Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR
Below: All cases of syphilis reported by the MoH by gender, 1994–2009. All cases identified by review of clinical records at the QPCC, 2009–2012.
Below: Number of congenital syphilis cases by year, per 1000 live births, 2003–2009
Below: Map of Trinidad with colours depicting density of cases per population density calculated using the Spatial Analyst Kernel Density Tool.
Objective. To describe the current epidemiological features of syphilis and congenital syphilis in Trinidad, 2009–2012.
Methods. All laboratory confirmed syphilis cases diagnosed through a vertical program in the Ministry of Health, between 1/1/2009 and 31/12/2012, were identified. All relevant data were collected including address which was geocoded and mapped using ArcGIS 10.0 (Esri). Both spatial techniques and standardized incidence ratios were used to determine hot spots.
Results. The annual cumulative incidence rate for syphilis remains high varying from 39 per 100 000 population in 2009 to 29 per 100 000 in 2012. We identified 3 “hot spots,” in urban areas of Trinidad. Young men and particularly young women in childbearing age 15–35 living in urban high density populations were commonly infected groups.
Conclusion. The incidence of syphilis continues to be very high in Trinidad. New initiatives will have to be formulated in order to attain the global initiative to eradicate syphilis by 2015.
Read more at: http://ht.ly/RLZcA HT https://twitter.com/NCBI
