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The Centers for Disease Control and Prevention (CDC) continues to warn about the potential ramifications of a rapidly spreading epidemic of sexually transmitted illnesses in the US and is urging coordinated action to halt the rise in neonatal syphilis cases.

“Syphilis during pregnancy can cause tragic outcomes, like miscarriage, stillbirth, infant death, and lifelong medical issues. Newborn syphilis occurs when mothers do not receive timely testing and treatment during pregnancy,” according to a recent press release received at our news desk.

More than 3,700 newborns were born with syphilis in 2022, more than ten times as many as in 2012, according to new CDC data. Rising syphilis cases among women of reproductive age, along with social and economic conditions that obstruct access to effective prenatal care and persistent reductions in the infrastructure and resources for prevention, are the reasons behind the rise in neonatal syphilis.

“The congenital syphilis crisis in the United States has skyrocketed at a heartbreaking rate. New actions are needed to prevent more family tragedies. We’re calling on healthcare providers, public health systems, and communities to take additional steps to connect mothers and babies with the care they need,” CDC Chief Medical Officer, Debra Houry, M.D., M.P.H, mentioned.

One of the biggest risk factors for syphilis for some people is where they live. According to previous CDC data, in 2021, more than 70 percent of the U.S. population lived in counties considered to have high rates of syphilis among reproductive-age women (above the Healthy People 2030 target).

Barriers to Timely Syphilis Testing and Treatment During Pregnancy

Barriers to timely syphilis testing and treatment at the individual and systemic levels result in missed opportunities to avoid neonatal syphilis during pregnancy. Substance abuse disorders and insurance denial are examples of hurdles at the individual level, but systematic racism and restricted access to healthcare are examples of barriers at the system level.

Tailored Prevention Strategies are Critical to Addressing Newborn Syphilis Disparities

“People from racial and ethnic minority groups are experiencing the brunt of the newborn syphilis epidemic. While newborn syphilis cases are increasing overall, babies born to Black, Hispanic, or American Indian/Alaska Native mothers were up to 8 times more likely to have newborn syphilis in 2021 than babies born to White mothers,” the document also reveals.

Decades of deeply ingrained socioeconomic determinants of health have led to these discrepancies, which increase barriers to high-quality healthcare and produce health inequities like higher prevalence of syphilis in some communities. Community health professionals play a crucial role in creating specialized plans to lower infant syphilis in each community. These workers include patient navigators, case managers, and disease intervention specialists. When it comes to reducing racial and ethnic differences in congenital syphilis, they are among the most influential.

“The congenital syphilis epidemic is an unacceptable American crisis. All pregnant mothers—regardless of who they are or where they live—deserve access to care that protects them and their babies from preventable diseases. Our nation should be proactive and think beyond the OB/GYN’s office and bridge prevention gaps. Every encounter a healthcare provider has with a patient during pregnancy is an opportunity to prevent congenital syphilis,” Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention, added.

CDC is urgently encouraging public health leaders and any healthcare provider with pregnant or reproductive-age patients to: - consider starting syphilis treatment right away following a positive rapid syphilis test during pregnancy if the patient faces greater obstacles to ongoing care (and still sends for full confirmatory syphilis testing for optimal patient follow-up); - use rapid syphilis testing and treatment during pregnancy in settings such as emergency departments, syringe service programs, prisons/jails, maternal and child health programs; - address syphilis before pregnancy in counties with high syphilis rates, by offering to screen sexually active women and their partners for syphilis, as well as people with other risk factors for syphilis; - work with local community health workers who can help to overcome additional barriers to syphilis testing and treatment during pregnancy.

Due to the increase in cases of syphilis and congenital syphilis in the United States, senior leadership at the U.S. Department of Health and Human Services (HHS) established the National Syphilis and Congenital Syphilis Syndemic Federal Taskforce dedicated to spearheading a national syphilis and congenital syphilis public health response. The overarching mission of this task force is to address the syndemic of syphilis and congenital syphilis, reduce their rates, promote health equity, and share resources with impacted communities.

In the U.S., 2022-2023 influenza activity began earlier than usual, increasing in October 2022, and has been associated with high rates of hospitalizations among children.

Influenza A(H3N2) represented most influenza viruses detected and sub-typed during the 2022-2023 Seasonal Influenza Vaccine Effectiveness (VE) period, but A(H1N1) pdm09 viruses co-circulated as well.

“Most viruses characterized were in the same genetic sub-clade as and antigenically similar to the viruses included in the 2022-2023 Northern Hemisphere influenza vaccine. Effectiveness of the influenza vaccine varies by season, influenza virus sub-type, and antigenic match with circulating viruses,” the CDC report sent to www.sursesiresurse.ro reveals.

The latest CDC Interim Estimates of 2022-2023 Seasonal Influenza Vaccine Effectiveness report used data from two concurrent studies conducted at Marshfield Clinic Health System (MCHS) in Wisconsin from October 23, 2022–February 10, 2023, to estimate influenza vaccine effectiveness (VE). Overall, VE was 54% against medically attended outpatient acute respiratory illness (ARI) associated with laboratory-confirmed influenza among patients aged 6 months–64 years. In a community cohort of children and adolescents aged <18 years, VE was 71% against symptomatic laboratory-confirmed influenza A virus infection. These interim analyses indicate that influenza vaccination substantially reduced the risk for medically attended influenza among persons aged <65 years and for symptomatic influenza in children and adolescents.

“Annual influenza vaccination is the best strategy for preventing influenza and its complications. CDC recommends that health care providers continue to administer annual influenza vaccine to persons aged ≥6 months as long as influenza viruses are circulating,” according to the CDC document.

Summary

Influenza activity for the 2022–23 winter season increased earlier than usual, with high rates of influenza-associated hospitalizations among children. The interim estimates of 2022–23 influenza VE (influenza vaccine effectiveness) from two concurrent studies in Wisconsin suggest that the current season’s influenza vaccines provide substantial protection against influenza.

“These findings are consistent with estimates reported in the Southern Hemisphere for the 2022 season and Canada for the current season, where similar viruses predominated. However, influenza vaccination coverage in the United States this season has been lower than during pre–COVID-19 pandemic seasons, particularly among children, pregnant women, and rural areas. Increased vaccination coverage is needed to realize the full potential of seasonal influenza vaccines,” the CDC report shows.

The interim estimates reported reflect early season VE and might differ from end-of-season VE estimates with additional enrollments, or if a change in circulating viruses would occur later in the season.

“Influenza activity was low nationally through the week ending February 4, 2023. However, CDC continues to monitor influenza activity through routine surveillance for any indications that activity might increase again; two waves of influenza activity have occurred during many previous seasons,” the CDC experts wrote.

Seasonal influenza vaccines protect against influenza A and B viruses, both of which might continue or begin to circulate later in the season, resulting in potentially serious complications.

Limitations

The findings in this report are subject to at least four limitations, CDC experts say.

First, the studies were restricted to participants from a single geographic area (central Wisconsin). However, viruses that predominated in the study population were similar to those that predominated across the U.S.

Second, older adults aged ≥65 years were excluded from the test-negative study. Age-specific VE estimates against influenza virus infection caused by A(H3N2) viruses are generally lower for older adults.

Third, sample sizes were small for the interim analysis, which limited the precision of VE estimates, and VE against illness associated with A(H1N1) pdm09 virus infections and the age-specific forecast could not be determined.

Finally, confounding and bias are of concern with observational studies; however, estimates were comparable across two study designs, and the test-negative study design yields valid estimates of influenza VE in most scenarios.

“Annual influenza vaccination is the best strategy for preventing influenza and its complications. During the 2022–23 season to date, influenza A viruses that predominated are genetically and antigenically similar to current vaccine components. Interim VE estimates from this report indicate that the current season’s influenza vaccine substantially reduces the risk for medical visits among persons aged 6 months–64 years and symptomatic illness associated with influenza A virus infection among children and adolescents aged <18 years. Influenza vaccination is recommended for all persons aged ≥6 months for as long as influenza viruses are circulating in the community,” the CDC report concludes.