Soaring congenital syphilis rates in US risk lives of thousands of babies

Health care advocates are calling on the Biden administration to declare a public health emergency due to the sharp rise in cases of congenital syphilis. The easily treatable infection has increased fivefold in 10 years and can have a distressing impact on children.

Congenital syphilis occurs when a baby contracts syphilis from its mother. Until 40% of babies born to untreated mothers will be stillborn or die. Others may develop serious birth defects, such as bone damage, anemia, blindness or deafness, and “neurological devastation.”

“There is not a single baby who should be born with syphilis in the US,” David Harvey, executive director of the National Coalition of STD Directors, told the Guardian. “We will be judged very harshly as a country and as a society for allowing this to happen to babies when it is so easy to diagnose, treat and prevent this disease.”

The rates of the disease have reached a almost 30 years high just as supplies of the drug of choice, called Bicillin LA, are in short supply. Syphilis can be cured with one to three injections of the drug.

Pfizer is the sole manufacturer of the drug, a form of the first antibiotic ever synthesized: penicillin. The company said She does not expect the shortages to be resolved before 2024 and partly blames the low supply on the increase in the number of syphilis cases.

That has led public health leaders to make the “uncomfortable” choice to target the medication almost exclusively to pregnant patients. Bicillin LA is the only drug known to safely treat syphilis during pregnancy, and is so crucial to the treatment of the pregnant person and the fetus that even people with a penicillin allergy will be given the drug after being checked by an allergist have been sensitized to.

Problematically, it also means that others have to rely on doxycycline, an antibiotic that must be taken twice a day for at least fourteen days, a schedule that some patients may find difficult to follow. Men who have sex with men are more likely to be diagnosed with syphilis. As a result, the bicillin shortage will likely hit the LGBTQ+ community the hardest.

“This is a direct reflection of an ailing public health system,” Harvey said. “We have the highest rates of sexually transmitted infections in the Western industrialized world, and it is a crisis in the US.”

Syphilis is one of a group of sexually transmitted infections (STDs) monitored by the government – ​​including chlamydia, gonorrhea and HIV – all of which are on the rise. Between 2020 and 2021, amid the disruptions caused by the pandemic, the US saw a 30.5% increase in cases of congenital syphilis.

The dramatic increase is not solely due to the pandemic. Syphilis was nearly eradicated in the early 1990s, when the HIV epidemic raised public awareness about the dangers of STDs, but the disease has returned amid stagnant and isolated public health funding.

Harvey called on the Biden administration to declare a public health emergency and use the Defense Production Act to produce more bicillin in the US. Furthermore, a coalition of 38 public health organizations this month called on the White House Drug Shortage Task Force to investigate the shortage.

A spokesperson for the Department of Health and Human Services (HHS) said that earlier this year the administration had already established “a federal task force dedicated to leading a national public health response against syphilis and congenital syphilis,” and that the task force had a mission to address the intertwined issues, “lowering rates and promoting equity in health care.” The task force is also prioritizing “technical assistance and other resources” for a dozen of the hardest-hit places in the US.

A White House spokesman said the administration remained focused on “critical supply chains” and has already issued five executive orders aimed at strengthening them.

“This work to strengthen pharmaceutical supply chains continues the work that began on day one of President Biden’s administration to ensure Americans have access to the medicines they need when they need them,” he said. a White House spokesperson told the Guardian.

However, public health officials in the worst-hit regions believe more needs to be done to tackle a ‘spike’ in cases that may be just the beginning. Due to the high rate of congenital syphilis in Mississippi, special attention has been paid the research of Drs. Manuela Staneva, Charlotte V Hobbs and Thomas Dobbs.

“It’s a national issue, and I think our work on this issue in Mississippi is just the tip of the iceberg,” said Dobbs, dean of the John D Bower School of Population Health at the University of Mississippi Medical Center. Dobbs said the situation was “absolutely” a public health emergency, although he did not call for an official declaration.

“National efforts are needed regardless of construction,” he said.

In 2021, the rate of congenital syphilis in the US was 77 cases per 100,000 live births, or 2,855 cases. By comparison, Britain reported a total of eleven cases five years from 2014 to 2019, the most recent year for which data is available. Because Britain had no cases in 2019, the effective rate is 0 per 100,000, according to the World Health Organisation.

At the same time, the US national rate masks the vastly uneven regional distribution of congenital syphilis in the US. Babies in the Southwest and the Deep South—border states and states where health care is the most difficult to access—are born with much higher rates of congenital syphilis than in the rest of the country.

Mississippi saw a rate of 74.5% “spike” in cases between 2020 and 2021. The state’s rate of 184 cases per 100,000 live births is more similar to that of Haiti (181 cases per 100,000) than in the US nationally. However, the highest rates in the country are in Arizona, where health authorities reported 232 cases per 100,000 live births.

The national figure also obscures places with few cases of syphilis — Maine, New Hampshire, Vermont and Wyoming have all but eliminated congenital syphilis. Each of them has had zero or just one case in five years.

Studies like those from researchers in Mississippi blame intersecting factors for the increase in syphilis in the Deep South and Southwest, starting with funding. The majority of resources to prevent and treat STDs come from the federal government. But since 2003, its financing has remained stagnant, losing 40% of its purchasing power to inflation.

In one example, health departments received a shock when the government agreed to reclaim $400 million in funding for Centers for Disease Control and Prevention that could have been used for disease intervention specialists – workers who find patients with STDs and break the chain of infection. The government signed the deal this summer under pressure to reach an agreement on the debt ceiling.

Federal funding silos have also made it difficult to direct money where it is needed in real time. In one case, silos and a lack of public funding led to the closure of an HIV clinic in southern Mississippi — even though the nearest clinic was 75 miles away, Dobbs reported in the magazine. Health matters.

“It’s a perfect storm for the increase in syphilis in the coming years,” Hobbs said. “In adults, in mothers and of course, unfortunately, also in children.”