Congenital syphilis: Notification and reality <b>[Abstract in English]</b>

Abstract

Aims: To study cases of congenital syphilis occurred in the Hospital de Referência Dona Regina (HRDR), in Palmas, capital of Tocantins state, in Brazil, seeking to evaluate the notification rate of this disease to the epidemiological surveillance system, and to identify some of the causes of its occurrence. Methods: This retrospective cross sectional study included all cases of congenital syphilis occurred in 2004 in the HRDR. The liveborns, stillborns and abortions that fit the case definition adopted by the Ministry of Health were considered as cases of congenital syphilis.The cases were identified through an active search in the hospital’s laboratory for parturient women with positive VDRL, followed by review of the patients’ hospital charts. The notified cases of Palmas were searched in the formularies submitted to the Notificating Diseases Information System. The total number of liveborns in Palmas, in 2004, was determined. Results: In 2004, 28 cases of congenital syphilis were identified in the HRDR, 23 live born infants and five fetal losses. In the same period, there were 3,851 live births in Palmas, 2,323 (60.3%) at the HRDR. The incidence of congenital syphilis in live born infants in the HRDR in 2004 was 23/2,323, or 9.9/1,000 (95% CI 6.4/1,000-14.6/1,000). Among the 28 cases of congenital syphilis, only 10 (36%) were notified, of whom all were live born infants. Hence, the notification rate was 64%. The totality of notified cases of congenital syphilis in Palmas was 10, all of them born at HRDR. Flaws in the prenatal care, and also in the newborn management, were found. Conclusions: A high sub-notification rate was observed in the HRDR and also in Palmas County. Epidemiological surveillance needs to be improved, as does the application of the official guidelines for pregnant women and newborn infants, in order to make the desired goal of elimination of congenital syphilis in Brazil possible. KEYWORDS: SYPHILIS, CONGENITAL/epidemiology; HEALTH SURVEILLANCE; CROSS SECTIONAL STUDIES; RETROSPECTIVE STUDIES; DISEASE NOTIFICATION.