摘要

Syphilis is a major public health problem in many regions of China, with increases in congenital syphilis (CS) cases causing concern. The Chinese Ministry of Health recently announced a comprehensive 10-y national syphilis control plan focusing on averting CS. The decision analytic model presented here quantifies the impact of the planned strategies to determine whether they are likely to meet the goals laid out in the control plan.Our model incorporated data on age-stratified fertility, female adult syphilis cases, and empirical syphilis transmission rates to estimate the number of CS cases associated with prenatal syphilis infection on a yearly basis. Guangdong Province was the focus of this analysis because of the availability of high-quality demographic and public health data. Each model outcome was simulated 1,000 times to incorporate uncertainty in model inputs. The model was validated using data from a CS intervention program among 477,656 women in China. Sensitivity analyses were performed to identify which variables are likely to be most influential in achieving Chinese and international policy goals. Increasing prenatal screening coverage was the single most effective strategy for reducing CS cases. An incremental increase in prenatal screening from the base case of 57% coverage to 95% coverage was associated with 106 (95% CI: 101, 111) CS cases averted per 100,000 live births (58% decrease). The policy strategies laid out in the national plan led to an outcome that fell short of the target, while a four-pronged comprehensive syphilis control strategy consisting of increased prenatal screening coverage, increased treatment completion, earlier prenatal screening, and improved syphilis test characteristics was associated with 157 (95% CI: 154, 160) CS cases averted per 100,000 live births (85% decrease).The Chinese national plan provides a strong foundation for syphilis control, but more comprehensive measures that include earlier and more extensive screening are necessary for reaching policy goals.

译文

梅毒是中国许多地区的一个主要公共卫生问题,先天性梅毒病例的增加引起了关注。中国卫生部最近宣布了一项全面的 10-y 国家梅毒控制计划,重点是避免 CS。这里提出的决策分析模型量化了计划策略的影响,以确定它们是否有可能达到控制计划中提出的目标。我们的模型包含了年龄分层生育能力、女性成人梅毒病例的数据,和经验梅毒传播率,以每年估计与产前梅毒感染相关的 CS 病例数。广东省是本次分析的重点,因为有高质量的人口和公共卫生数据。每个模型结果被模拟 1,000 次,以在模型输入中纳入不确定性。使用来自中国 477,656 名女性的 CS 干预项目的数据验证了该模型。进行敏感性分析,以确定哪些变量可能对实现中国和国际政策目标最有影响力。增加产前筛查覆盖率是减少 CS 病例的唯一最有效策略。逐步增加的产前检查的基本情况的 57% 95% 万个覆盖面较之 106 (95% CI: 101 、 111) CS 每 100,000 例活产情况下避免 (减少 58%)。国家计划中制定的政策战略导致了一个没有达到目标的结果,而四管齐下的全面梅毒控制战略包括增加产前筛查覆盖面,增加治疗完成, 早期产前筛查和改善的梅毒检测特征与 157 相关 (95% CI: 154,160)每 100,000 例活产中避免了 CS 病例 (减少 85%)。中国国家计划为梅毒控制提供了坚实的基础,但是包括更早和更广泛的筛查在内的更全面的措施对于实现政策目标是必要的。

Congenital Syphilis

儿科 传染疾病 疾病
概述  :  

 梅毒是由苍白螺旋体引起的一种慢性、系统性的性传播疾病。可分为后天获得性梅毒和胎传梅毒(先天梅毒)。获得性梅毒又分为早期和晚期梅毒。早期梅毒指感染梅毒螺旋体在2年内。晚期梅毒的病程在2年以上。神经梅毒在梅毒早晚期均可发生。先天性梅毒是指梅毒螺旋体由母体经胎盘进入胎儿血液循环所致的感染。梅毒螺旋体经胎盘传播多发生在妊娠4个月后。先天性梅毒又分为早期)和晚期(出生2年后发病)。 临床表现 ① 多为早产儿、低出生体重儿或小于胎龄儿;发育、营养状况均落后于同胎

congenital  /kən'dʒenɪt(ə)l/  /kən'dʒɛnɪtl/

       adj. 先天的,天生的;天赋的

       Cleft lip and palate is one of the most common congenital malformation. 唇腭裂畸形是人类最常见的先天发育性缺陷之一。


syphilis  /'sɪfɪlɪs/   /'sɪfɪlɪs/

       n. [性病] 梅毒

       Syphilis can cause spontaneous abortion, stillbirth, irreversible congenital defects, and perinataldeath. 梅毒可引起自发流产,死产,不可逆转的先天性缺陷,及围产期死亡。


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