Mortality associated with congenital syphilis in the United States, 1992-1998
Mortality associated with congenital syphilis in the United States, 1992-1998
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DOI：
10.1542/peds.109.5.e79
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发表时间：
2002-05-01
期刊：
影响因子：
8
通讯作者：
Berman, SM
中科院分区：
文献类型：
--
作者：
Gust, DA;Levine, WC;Berman, SM
Objective.总结全国先天性梅毒（CS）发病率和相关死亡率的趋势。我们分析了1992- 1998年美国50个州和哥伦比亚特区向疾病控制和预防中心报告的CS监测数据。从1992-1998年，在14627例CS病例中报告了942例死亡，包括760例死胎，得出病死率（死胎和死亡/所有病例）为6.4%。妊娠期间未接受治疗、治疗不当或未记录的梅毒治疗占报告病例的87.4%。在CS病例中，产前检查次数（0，1-4，5-9，> 10）与致死性结局风险呈负相关。在死亡者中，52%的分娩发生在妊娠30周之前。在患有CS的活产婴儿中，未报告X光片或脑脊液评估的婴儿死亡率更高。尽管1992-1998年CS的病例数和死亡数均有所下降，但病死率无显著变化。与CS相关的死亡率仍然是一个重要的公共卫生问题，如果成人梅毒发病率增加，这一问题将再次出现。由于很大比例的死亡发生在低胎龄，早期诊断和治疗孕产妇梅毒可大大降低病死率。
Objective. To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality.Methods. We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992-1998.Results. From 1992-1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.4%. Untreated, inadequately treated, or undocumented treatment of syphilis during pregnancy accounted for 87.4% of reported cases. Among CS cases, there was an inverse relationship between the number of prenatal care visits (0, 1-4, 5-9, > 10) and risk of fatal outcome. Among deaths, 52% of deliveries occurred by 30 weeks' gestation. Among live born infants with CS, death occurred more often in infants for whom no radiograph or cerebrospinal fluid evaluation was reported. Although both cases and deaths from CS declined from 1992-1998, there was no significant change in the case fatality ratio.Conclusion. Mortality associated with CS continues to be an important public health problem that will resurge if adult syphilis rates increase. Because a large proportion of deaths occur at low gestational age, earlier diagnosis and treatment of maternal syphilis may substantially reduce the case fatality ratio.