Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Clin Infect Dis. 2021 Mar 1;72(5):e79-e87. doi: 10.1093/cid/ciaa1716.
The Pan American Health Organization indicates that increased incidence of congenital syphilis (CS) can be attributed to the lack of penicillin. This study aimed to analyze the relationship between the benzathine penicillin shortage and the significant increase in the incidence of congenital syphilis in the city of Rio de Janeiro from 2013 to 2017.
We used a mixed ecologic study design (temporal and multiple groups). Analysis units were the neighborhoods (spatial) and quarters (temporal) during those years. The study population consisted of CS patients who were living in the city of Rio de Janeiro. The benzathine penicillin supply measure for use in gestational syphilis considered the ratio between (1) the number of bottles dispensed to health facilities in each neighborhood and (2) the number of bottles necessary to treat pregnant women diagnosed with syphilis and their respective partners residing in each neighborhood. To evaluate the association between shortages and a significant increase in CS incidence, the negative-inflated zero-binomial regression model (longitudinal model) was used.
During the study period, the incidence rate of CS in Rio de Janeiro neighborhoods was on average 19.6 per 1000 live births. In the simple analysis, shortage was associated with a 2.17-fold increase in the risk of a significant increase in CS incidence. After adjustment for the sufficient minimum set, the strength of association increased to 2.23 (95% confidence interval, 1.15-4.30).
We conclude that the benzathine penicillin shortage had an impact on the increase in the incidence of CS in Rio de Janeiro.
泛美卫生组织指出，先天性梅毒（CS）发病率的增加可归因于青霉素的缺乏。本研究旨在分析从 2013 年到 2017 年，里约热内卢市先天梅毒发病率显著增加与卞星青霉素短缺之间的关系。
我们使用混合生态研究设计（时间和多组）。分析单位为这些年的街区（空间）和季度（时间）。研究人群包括居住在里约热内卢市的 CS 患者。用于治疗妊娠梅毒的卞星青霉素供应措施考虑了以下两个比值：（1）每个街区的卫生机构分发的瓶数与（2）每个街区需要治疗的诊断患有梅毒及其各自伴侣的孕妇的瓶数。为了评估短缺与 CS 发病率显著增加之间的关联，我们使用负膨胀零二项回归模型（纵向模型）。
在研究期间，里约热内卢市街区的 CS 发病率平均为每 1000 例活产 19.6 例。在简单分析中，短缺与 CS 发病率显著增加的风险增加 2.17 倍相关。在调整了充足的最小集合后，关联强度增加到 2.23（95%置信区间，1.15-4.30）。
我们得出结论，卞星青霉素短缺对里约热内卢 CS 发病率的增加产生了影响。
