Braga Natalia A, de Oliveira Garcia Mateos Sheila, Buccheri Renata, Avelino-Silva Vivian I, Warden Donald E, de Almeida-Neto Cesar, Ribeiro Maisa, Amorim Luiz, Loureiro Paula, Fraiji Nelson, Oikawa Marcio K, Grebe Eduard, Stone Mars, Sabino Ester C, Custer Brian
Faculdade de Medicina da, Universidade de Sao Paulo, Sao Paulo, Brazil.
Universidade Municipal de Sao Caetano Do Sul, Sao Caetano Do Sul, Brazil.
BMC Public Health. 2025 Jan 7;25(1):60. doi: 10.1186/s12889-024-21114-3.
Increasing syphilis infection rates are a concerning issue worldwide. Blood donation screening is an opportunity to monitor the burden of asymptomatic infections, providing information on contemporary factors associated with infection and public health insights into transmission.
Blood donations collected at five Brazilian blood centers between January 2020 and February 2022 were screened with treponemal or non-treponemal assays according to local protocols, followed by alternate Enzyme-Linked Immunosorbent Assay (ELISA); samples with reactive or indeterminate results in the alternate ELISA were further tested with the rapid plasma reagin (RPR), and categorized as RPR-positive or RPR-negative. RPR-positive donations were also grouped according to RPR titers (< 1:8 or ≥ 1:8). We report the prevalence of syphilis in first-time donors (FTD) and repeat donors (RD), as well as incidence in RD. Multivariable models were used to assess factors associated with RPR-positive syphilis. Additionally, we explored the relationship between syphilis positivity in FTD and syphilis cases registered by the Brazilian public health surveillance system from 2012 to 2022.
Of 862,146 donations, 10,771 (1.3%) were reactive or indeterminate on screening; 7,541 available samples underwent additional testing. Of those, 5,876 (77.9%) tested positive or indeterminate on the alternate ELISA; 907 (12.0%) were RPR-negative, 2,980 (39.5%) were RPR-positive < 1:8, and 1,989 (26.4%) were RPR-positive with titers ≥ 1:8. The prevalence of syphilis including RPR-positive and RPR-negative cases was 2.5% among FTD and 0.6% among RD. The incidence of syphilis in RD was 90/10 person-years (95% CI 86-95), with younger age, male gender, Black and Mixed race (relative to White) and lower education associated with incident syphilis in RD. Blood donors had lower rates of syphilis compared to the general population, with correspondence between numbers in blood donors and congenital syphilis rates registered by the Brazilian surveillance system between 2012 and 2022.
The prevalence of syphilis was < 3% among FTD and < 1% among RD. We found wide variability according to donor characteristics, with gender, age, race, and schooling significantly associated with prevalent and incident RPR-positive syphilis in multivariable models. Syphilis occurrence among blood donors can be used to assess disease patterns in low-risk populations.
梅毒感染率不断上升是全球一个令人担忧的问题。献血筛查是监测无症状感染负担的一个契机，可提供与感染相关的当代因素信息以及对传播情况的公共卫生见解。
根据当地方案，对2020年1月至2022年2月期间在巴西五个血液中心采集的献血进行梅毒螺旋体或非梅毒螺旋体检测，随后进行交替酶联免疫吸附测定（ELISA）；在交替ELISA中结果呈反应性或不确定的样本进一步用快速血浆反应素（RPR）检测，并分类为RPR阳性或RPR阴性。RPR阳性的献血也根据RPR滴度（<1:8或≥1:8）分组。我们报告了首次献血者（FTD）和重复献血者（RD）中梅毒的患病率以及RD中的发病率。使用多变量模型评估与RPR阳性梅毒相关的因素。此外，我们探讨了FTD中梅毒阳性与巴西公共卫生监测系统2012年至2022年登记的梅毒病例之间的关系。
在862,146份献血中，10,771份（1.3%）在筛查时呈反应性或不确定；7,541份可用样本接受了额外检测。其中，5,876份（77.9%）在交替ELISA中检测呈阳性或不确定；907份（12.0%）为RPR阴性，2,980份（39.5%）为RPR阳性<1:8，1,989份（26.4%）为RPR阳性且滴度≥1:8。包括RPR阳性和RPR阴性病例在内的梅毒患病率在FTD中为2.5%，在RD中为0.6%。RD中梅毒的发病率为90/10人年（95%CI 86 - 95），年龄较小、男性、黑人和混血种族（相对于白人）以及教育程度较低与RD中梅毒发病相关。献血者的梅毒发病率低于普通人群，献血者中的梅毒病例数与巴西监测系统2012年至2022年登记的先天性梅毒发病率相符。
梅毒患病率在FTD中<3%，在RD中<1%。我们发现根据献血者特征存在很大差异，在多变量模型中，性别、年龄、种族和受教育程度与RPR阳性梅毒的患病率和发病率显著相关。献血者中梅毒的发生情况可用于评估低风险人群中的疾病模式。
