Taylor Melanie M, Nurse-Findlay Stephen, Zhang Xiulei, Hedman Lisa, Kamb Mary L, Broutet Nathalie, Kiarie James
Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, United States of America.
Department of Reproductive Health, World Health Organization, Geneva, Switzerland.
PLoS One. 2016 Jul 19;11(7):e0159483. doi: 10.1371/journal.pone.0159483. eCollection 2016.
Congenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis.
Proportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis.
Using current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases.
Penicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis are important for congenital syphilis prevention, and will be increasingly critical in the future as more countries move toward elimination targets.
先天性梅毒仍然是全球死产以及新生儿发病和死亡的一个可预防原因。梅毒高发病率国家报告了注射用青霉素短缺的情况，而注射用青霉素是唯一推荐用于患有梅毒的孕妇和婴儿的治疗药物。我们试图估算30个高发病率国家在产前保健机构中当前及预计的苄星青霉素年度需求量，这些国家约占全球先天性梅毒负担的33%。
将向世界卫生组织报告的产前保健就诊比例、孕期梅毒筛查覆盖率、孕妇梅毒患病率以及未经治疗的孕产妇梅毒导致的不良妊娠结局比例，应用于30个梅毒高负担国家2012年的出生估计数，以估算当前及预计预防先天性梅毒所需的苄星青霉素量。
利用当前的产前保健梅毒筛查覆盖率和血清阳性率，我们估计在这30个国家中，至少需要注射一剂240万单位苄星青霉素进行治疗的女性总数为351,016人。所有30个国家的梅毒筛查覆盖率达到或高于95%，将使需要用苄星青霉素治疗的女性人数增加到712,030人。根据世界卫生组织的管理指南，对于孕期梅毒检测呈阳性并接受治疗的母亲所生的活产婴儿，还需要351,016剂按体重计算的苄星青霉素。假设青霉素供应充足且为所有诊断为梅毒的母亲提供治疗，总体上估计可预防95,938例不良出生结局，包括37,822例死产、15,814例新生儿死亡以及34,088例其他先天性梅毒病例。
在这组梅毒负担较重的国家中，母婴梅毒治疗对青霉素的需求量很大。确保有稳定且充足的苄星青霉素供应以治疗孕产妇梅毒的举措对于预防先天性梅毒很重要，并且随着越来越多国家朝着消除目标迈进，在未来将变得愈发关键。
