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巴西梅毒的时空分布分析：2001-2017 年先天性梅毒和孕妇梅毒病例。

Spatiotemporal distribution analysis of syphilis in Brazil: Cases of congenital and syphilis in pregnant women from 2001-2017.

机构信息

Advanced Public Health laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation (Fiocruz-BA), Salvador, Bahia, Brazil.

Salvador University (UNIFACS), Salvador, Bahia, Brazil.

出版信息

PLoS One. 2022 Oct 6;17(10):e0275731. doi: 10.1371/journal.pone.0275731. eCollection 2022.

DOI:10.1371/journal.pone.0275731
PMID:36201505
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9536537/
Abstract

In Brazil, the notification of congenital (CS) and syphilis in pregnant women (SiP) is compulsory. Notification data provided by the Ministry of Health in combination with the mapping of vulnerable geographic areas is essential to forecasting possible outbreaks and more effectively combating infection through monitoring. We aim to evaluate the spatiotemporal distribution and epidemiological aspects of reported cases of CS and SiP in Brazil. A retrospective ecological study was carried out using secondary surveillance data obtained from the Brazilian National Notifiable Diseases Information System (SINAN) database, considering all reported cases of CS and SiP between 2001 to 2017. Epidemiological characteristics and time trends were analyzed using joinpoint regression models and spatial distribution, considering microregions or states/macroregions as units of analysis. A total of 188,630 (359/100,000 birth lives) CS and 235,895 of SiP (6.3/100,000 inhabitants) were reported during the period studied. In general, the epidemiologic profile of Brazil indicates most reported CS cases occurred in "mixed-race" newborns who were diagnosed within seven days of birth and whose mothers had received prenatal care, but the epidemiologic profile varies by Brazilian macroregion. Regarding SiP, most cases were among women who self-reported 'mixed-race', were aged 20-39 years, had up to eight years of formal education and were diagnosed with primary or latent syphilis. Approximately 549 (98.4%) and 558 (100%) microregions reported at least one case of CS and SiP, respectively. From 2012 to 2016, CS cases increased significantly in almost all Brazilian states, most notably in the South, Southeast, and Central-West macroregions, from 2001-2017 and the relative risk (RR) of SiP increased around 400% (RR: 1,00 to 445,50). Considering the epidemiological scenario of the infection in Brazil, it is necessary to enhance preventive, control and eradication measures.

摘要

在巴西，孕妇先天性梅毒（CS）和梅毒（SiP）的通报是强制性的。卫生部提供的通报数据与脆弱地理区域的绘图相结合，对于预测可能的疫情爆发和通过监测更有效地控制感染至关重要。我们旨在评估巴西报告的先天性梅毒和梅毒病例的时空分布和流行病学特征。采用回顾性生态研究，使用从巴西国家传染病监测系统（SINAN）数据库获得的二级监测数据，对 2001 年至 2017 年期间所有报告的先天性梅毒和梅毒病例进行研究。使用 Joinpoint 回归模型分析流行病学特征和时间趋势，并考虑微区或州/大区作为分析单位进行空间分布。在所研究期间，共报告了 188,630 例（每 10 万活产 359 例）先天性梅毒和 235,895 例梅毒（每 10 万居民 6.3 例）。总体而言，巴西的流行病学特征表明，大多数报告的先天性梅毒病例发生在“混血”新生儿中，这些新生儿在出生后七天内被诊断出来，并且其母亲接受了产前保健，但巴西的流行病学特征因大区而异。关于梅毒，大多数病例发生在自我报告为“混血”的女性中，年龄在 20-39 岁之间，受正规教育不到八年，且被诊断为原发性或潜伏性梅毒。约有 549（98.4%）和 558（100%）微区分别报告了至少 1 例先天性梅毒和梅毒病例。从 2012 年到 2016 年，巴西几乎所有州的先天性梅毒病例都显著增加，特别是在南部、东南部和中西部大区，从 2001 年至 2017 年，梅毒的相对风险（RR）增加了约 400%（RR：1.00 至 445.50）。考虑到巴西感染的流行病学情况，有必要加强预防、控制和消除措施。

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