Congenital syphilis: an economic evaluation of a prevention program in China.

BACKGROUND: Until now there has been no data to show the effectiveness or benefits of screening for syphilis in gravidas in China. This study was to assess the effectiveness of a program preventing mother-to-child-transmission of syphilis and to reveal factors impacting the benefit. METHODS: A cohort of 159,017 gravidas were screened for syphilis by serologic methods and infected individuals were treated with 3 injections of 2.4 million units of benzathine penicillin in Shenzhen in 2005. The pregnancy outcomes were compared for this cost-effectiveness analysis in 2 scenarios, intervention with screening and treatment versus no intervention. RESULTS: Eight hundred twenty-seven pregnant women (0.52%) were diagnosed with syphilis and treated subsequently. Of these, 200 gestations ended in miscarriage. Four babies were diagnosed with congenital syphilis; 25 neonates with low birth weight; 1 died after birth. The total cost was $636,748. On average, every $770 identified 1 infected mother. Every $4391 prevented 1 congenital syphilis; every $5135 prevented 1 low birth weight; and every $7075 prevented 1 death. One disability adjusted life year could be saved by $215. In total the program reached a benefit to cost ratio of 21.76. Sensitivity analyses revealed that this ratio was mainly impacted by the prevalence of syphilis in pregnant women and the rate of miscarriage. CONCLUSIONS: Screening for antenatal syphilis combined with intervening during gestation is highly effective in China. Reducing the percentage of spontaneous/induced abortion would be one of the most effective methods of further increasing the benefits of this screening.

[Study on the status of syphilis infection and its influence factors on pregnant women in Shenzhen].

OBJECTIVE: Through questionnaire and screening, epidemiology of syphilis in pregnant women and related risk factors were studied, to develop effective policy and reducing the negative impact of the disease. METHODS: All pregnant women who appeared at the hospitals the first time, were included, in Shenzhen city. Tolulized Red Unheated Serum Test (TRUST) method was used for primary screening and positive results were confirmed by the Treponema Pallidum Particle Agglutination (TPPA) test at the Shenzhen Center for Disease Control and Prevention (SZCDC). Positive patients were informed and treated and the pregnancies were managed accordingly at the SZCDC. RESULTS: From 2003-2005, 418,871 (94.7%) pregnant were screened. Epidemiological and treatment data were collected from 2019 positive cases of infectious syphilis (0.48%). Among them, 94.2% were between 20 and 35 years old, with 93.6% of them had only junior high school education and 63.4% of them worked as commercial services or jobless which was significantly higher than other occupations (OR = 8.628). 89.5% of them were from other cities, significantly higher than from local residents (OR = 8.733). Gestational weeks at original diagnosis was longer and the infection rate higher. CONCLUSION: The infection rate of syphilis in Shenzhen was still at a high level which was related to occupation, education level, place of residency, gestational weeks at first diagnosis etc. Further screening measures and early intervention were important.