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We agree with David Mabey and Rosanna Peeling1 that the Review by Sarah Hawkes and colleagues2 is a “timely reminder that syphilis has not disappeared, and remains a major, although entirely preventable, cause of death in newborn babies”. This reminder echoes what we wrote 10 years ago3 and highlights the absence of progress made in the intervening years. In 2007, WHO launched its global initiative to eliminate congenital syphilis. 5 years later, evidently, little has changed.
Correspondence Centers for Disease Control and Prevention, Atlanta, makers might have chosen to give 1 Mabey D, Peeling RW. Syphilis, still a major GA, USA (THH); and Medical Research Council, Cape cause of infant mortality. Lancet Infect Dis little attention to the scourge of 2011; 11: 654–55. Town, South Africa (RR, TM) congenital syphilis in part because 2 Hawkes S, Matin N, Broutet N, Low N. 1 Holtz TH, Kabera G, Mthiyane T, et al. Use of a WHO-recommended algorithm to reduce of two Cochrane systematic Eﬀectiveness of interventions to improve screening for syphilis in pregnancy: a mortality in seriously ill patients with HIV reviews,4,5 which they incorrectly systematic review and meta-analysis. infection and smear-negative pulmonary tuberculosis in South Africa: an observational claimed showed “no good evidence Lancet Infect Dis 2011; 11: 684–91. cohort study. Lancet Infect Dis 2011; that the treatment of syphilis 3 Walker DG, Walker GJ. Forgotten but not gone: 11: 533–40. the continuing scourge of congenital syphilis. in pregnant women improved Lancet Infect Dis 2002; 2: 432–36. 2 WHO. Improving the diagnosis and treatment of smear-negative pulmonary and pregnancy outcome”. However, the 4 Walker GJA. Antibiotics for syphilis diagnosed extrapulmonary tuberculosis among adults systematic review,4 authored by one during pregnancy. Cochrane Database Syst Rev and adolescents: recommendations for HIV- 2001; 3: CD001143. prevalent and resource-constrained settings. of us, concluded that “...there is no 5 Blencowe H, Cousens S, Kamb M, Berman S, Geneva: World Health Organization; 2007. doubt that penicillin is eﬀective in Lawn JE. Lives saved tool supplement 3 Wilson D, Mbhele L, Badri M, et al. Evaluation detection and treatment of syphilis in the treatment of syphilis in pregnancy pregnancy to reduce syphilis related stillbirths of the World Health Organization algorithm for the diagnosis of HIV-associated sputum and the prevention of congenital and neonatal mortality. BMC Public Health smear-negative tuberculosis. syphilis”. The second review5 men- 2011; 11 (suppl 3): S9. Int J Tuberc Lung Dis 2011; 15: 919–24. 6 Walker DG, Walker GJA. Prevention of 4 Schaaf HS, Nel ED, Beyers N, Gie RP, Scott F, tioned by Mabey and Peeling1 states congenital syphilis—time for action. Donald PR. A decade of experience with that “detection and appropriate, Bull World Health Organ 2004; 82: 401. Mycobacterium tuberculosis culture from timely penicillin treatment is a highly 7 Walker GJA, Walker DG. Congenital syphilis: children: a seasonal inﬂuence on incidence of a continuing but neglected problem. childhood tuberculosis. Tuber Lung Dis 1996; eﬀective intervention to reduce Semin Fetal Neonatal Med 2007; 12: 198–206. 77: 43–46. adverse syphilis-related pregnancy 5 Koole O, Colebunders R. Reducing mortality outcomes”. from HIV infection and tuberculosis. Lancet Infect Dis 2011; 11: 494–95. To misinterpret the ﬁndings We read with interest Sarah Hawkes of systematic reviews and place and colleagues’ Article1 that assessed responsibility on them for the failure the eﬀectiveness of interventions to adequately control congenital to improve screening for syphilis in Syphilis: still a major syphilis diverts attention away from pregnancy. The investigators highlight organisations such as WHO, which several possible interventions during cause of infant should be working with governments pregnancy and suggest that antenatal mortality and other partners to increase syphilis screening could reduce the We agree with David Mabey and eﬀorts to tackle congenital syphilis. incidence of perinatal death and Rosanna Peeling1 that the Review Unfortunately, babies in countries as stillbirths attributable to syphilis by by Sarah Hawkes and colleagues2 diverse as Australia, Belarus, China, 50%. In addition to the interventions is a “timely reminder that syphilis and Haiti continue to be born with during pregnancy, we would like to has not disappeared, and remains a congenital syphilis. This situation draw attention to the importance major, although entirely preventable, should be unacceptable. That of premarital syphilis screening for cause of death in newborn babies”. antenatal screening and treatment prevention of adverse syphilis-related This reminder echoes what we can work is well known, and yet there pregnancy outcomes in syphilis- wrote 10 years ago3 and highlights has been limited success over the epidemic countries such as China. the absence of progress made in past decade in controlling, let alone In China, premarital check-ups the intervening years. In 2007, WHO eliminating, congenital syphilis. As that include syphilis screening were launched its global initiative to we have argued previously on several requested by the Law Concerning the eliminate congenital syphilis. 5 years occasions,3,4,6,7 the time has come to Mother and Infant Care in 1994.2 As a later, evidently, little has changed. be more ambitious, resourceful, and result of implementation of the Law, In 2002, we argued for a task-force innovative in preventing this tragedy. the proportion of prospective couples approach by international health Business as usual is not an option. receiving premarital syphilis checkups agencies, which gives a focused but We declare that we have no conﬂicts of interest. increased steadily to a national rate ﬂexible commitment to dealing with of 68% in 2002.3 However, this rate this tragic situation, rather than one Damian G Walker, Godfrey J A Walker dropped substantially to less than relying only on traditional antenatal email@example.com 5% after introduction of the revised screening and treatment.3 Mabey and Health Economics and Financing, Global Health, Bill Regulations Governing Marriage and Melinda Gates Foundation, Seattle, WA, USA Peeling1 and Hawkes and colleagues2 (DGW); and School of Reproductive and Registration in 2003, in which ignored the conclusions of our 2002 Developmental Medicine, Division of Perinatal and compulsory premarital check-ups Personal View. Furthermore, Mabey Reproductive Medicine, The University of Liverpool, were abolished,4 partly because of Liverpool, UK (GJAW) and Peeling1 suggest that policy the negative attitude toward the www.thelancet.com/infection Vol 12 April 2012 269
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