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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The rapid social&#44; political&#44; and economic transformations in Russia after the break-up of the Soviet Union led to a change in the traditional approach to sexual habits and values among the population&#46; This was accompanied by a deterioration in the public health service&#44; including prevention and control of sexually transmitted infections&#44; which led to a dramatic increase in the frequency of syphilis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This increase was so pronounced that in 1996&#44; the rate &#40;254&#46;2 cases per 100&#8239;000 inhabitants&#41; was 48 times greater than in 1989&#46; The disease mainly affected young women&#44; and the number of reported cases of congenital syphilis multiplied 26-fold during the period 1991&#8211;1999 &#40;from 8&#46;04 per 100&#8239;000 to 209 per 100&#8239;000&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Rates have fallen since then&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> although the incidence has remained high &#40;56&#46;7 per 100&#8239;000 in 2005&#59; 30&#46;5 per 100&#8239;000 in 2010&#59; 23&#46;6 per 100&#8239;000 in 2015&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Russia is a key country for international adoption in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the present investigation&#44; we analyzed a cohort of children adopted from Russia to determine the prevalence of active maternal syphilis during pregnancy&#44; congenital syphilis in children&#44; and the results of serology testing for syphilis after arrival in Spain&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 450 children adopted from Russia were studied after their arrival in Spain during the period 2000&#8211;2017 at the Center for Pediatrics and International Adoption &#40;Centro de Pediatr&#237;a y Adopci&#243;n Internacional&#41; in Zaragoza&#46; The mean &#40;SD&#41; age was 31&#46;3 &#40;18&#46;3&#41; months&#44; and 62&#46;2&#37; were boys&#46; Similarly&#44; we evaluated the preadoption medical reports from Russia&#46; It is important to remember that the absence of a history of syphilis in the preadoption medical report does not rule the disease out&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In line with the state consensus document on the basic medical evaluation of children adopted from overseas&#44; all of the children underwent serology testing for syphilis &#40;rapid plasma reagin or venereal disease research laboratory test&#41;&#46; If the reagin tests are positive&#44; then a treponema-specific test &#40;fluorescent treponemal antibody absorption&#41; is necessary for confirmation&#46; This test is also performed in all children aged under 1&#8239;year when there is high clinical suspicion or confirmation that the biological mother had syphilis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Evaluation of preadoption medical reports revealed that at least 16&#37; &#40;n&#8239;&#61;&#8239;72&#41; of the biological mothers had active syphilis during pregnancy and that at least 32&#37; &#40;n&#8239;&#61;&#8239;23&#41; of children of a mother with active syphilis had congenital syphilis&#46; The sensorineural and physical examination the children underwent after arrival did not reveal lesions or stigmata that are characteristic of the disease in any cases&#44; and the syphilis serology test result was negative in all cases&#46; A treponema-specific test performed in 5&#8239;children aged &#60;1&#8239;year whose mothers had confirmed syphilis yielded a negative result&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Epidemiological and clinical studies performed by the Congenital Syphilis Investigation Team &#40;CSIT&#41; of the Russian Ministry of Health reported that in Russian pregnant women with active syphilis&#44; between 25&#37; and 64&#37; had a newborn with congenital syphilis&#46; They also found that in the case of pregnant women who did not undergo medical check-ups for their pregnancy or who had their first check-up late &#40;&#62;&#8239;28 weeks&#41; and did not receive treatment or received insufficient treatment or did not complete treatment&#44; the risk of congenital syphilis in the newborn was as high as 86&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> In Russia&#44; appropriate treatment of primary&#44; secondary&#44; and all forms of latent syphilis during pregnancy comprises administration of long-acting penicillin G benzathine&#44; as well as daily administration of short-acting penicillin G procaine&#46; Either of these 2 therapy regimens must be completed at least 30 days before delivery&#46; The regulations stipulate that only dermatologists and venereologists are authorized to treat pregnant women infected by syphilis&#44; although&#44; as a result of the recommendations of the CSIT&#44; national policy is beginning to be reformed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> For a child to be diagnosed with congenital syphilis in Russia&#44; he&#47;she must have clinical symptoms or persistent serological abnormalities&#46; According to the CSIT&#44; these requirements may lead the frequency of the disease to be underestimated&#44; since they do not consider asymptomatic children&#44; i&#46;e&#46;&#44; the majority&#44; to be probable cases&#46; Most of these children were born to mothers with untreated or inadequately treated syphilis&#46; In any case&#44; health care policy stipulates that the children must receive preventive treatment with penicillin&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The prevalence of early and late congenital syphilis in children adopted from Russia is lower than 0&#46;05&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> thus indicating that they are well diagnosed&#44; treated&#44; and followed up in their country of origin&#46; In any case&#44; despite this low prevalence&#44; we consider it important to continue screening for syphilis after the child&#8217;s arrival in the country of adoption&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Case and Research Letters
Prevalence of Syphilis in Children Adopted From Russia
Prevalencia de sífilis en niños adoptados de Rusia
G. Oliván-Gonzalvo
Centro de Pediatría y Adopción Internacional, Zaragoza, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incidence of syphilis in Russia &#40;1995&#8211;2015&#41;&#46; Source&#58; Federal Statistics Service of the Russian Federation&#58; Available at&#58; <span class="elsevierStyleInterRef" id="intr0005" href="https://www.gks.ru">https&#58;&#47;&#47;www&#46;gks&#46;ru</span>&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The rapid social&#44; political&#44; and economic transformations in Russia after the break-up of the Soviet Union led to a change in the traditional approach to sexual habits and values among the population&#46; This was accompanied by a deterioration in the public health service&#44; including prevention and control of sexually transmitted infections&#44; which led to a dramatic increase in the frequency of syphilis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This increase was so pronounced that in 1996&#44; the rate &#40;254&#46;2 cases per 100&#8239;000 inhabitants&#41; was 48 times greater than in 1989&#46; The disease mainly affected young women&#44; and the number of reported cases of congenital syphilis multiplied 26-fold during the period 1991&#8211;1999 &#40;from 8&#46;04 per 100&#8239;000 to 209 per 100&#8239;000&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Rates have fallen since then&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> although the incidence has remained high &#40;56&#46;7 per 100&#8239;000 in 2005&#59; 30&#46;5 per 100&#8239;000 in 2010&#59; 23&#46;6 per 100&#8239;000 in 2015&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Russia is a key country for international adoption in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the present investigation&#44; we analyzed a cohort of children adopted from Russia to determine the prevalence of active maternal syphilis during pregnancy&#44; congenital syphilis in children&#44; and the results of serology testing for syphilis after arrival in Spain&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 450 children adopted from Russia were studied after their arrival in Spain during the period 2000&#8211;2017 at the Center for Pediatrics and International Adoption &#40;Centro de Pediatr&#237;a y Adopci&#243;n Internacional&#41; in Zaragoza&#46; The mean &#40;SD&#41; age was 31&#46;3 &#40;18&#46;3&#41; months&#44; and 62&#46;2&#37; were boys&#46; Similarly&#44; we evaluated the preadoption medical reports from Russia&#46; It is important to remember that the absence of a history of syphilis in the preadoption medical report does not rule the disease out&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In line with the state consensus document on the basic medical evaluation of children adopted from overseas&#44; all of the children underwent serology testing for syphilis &#40;rapid plasma reagin or venereal disease research laboratory test&#41;&#46; If the reagin tests are positive&#44; then a treponema-specific test &#40;fluorescent treponemal antibody absorption&#41; is necessary for confirmation&#46; This test is also performed in all children aged under 1&#8239;year when there is high clinical suspicion or confirmation that the biological mother had syphilis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Evaluation of preadoption medical reports revealed that at least 16&#37; &#40;n&#8239;&#61;&#8239;72&#41; of the biological mothers had active syphilis during pregnancy and that at least 32&#37; &#40;n&#8239;&#61;&#8239;23&#41; of children of a mother with active syphilis had congenital syphilis&#46; The sensorineural and physical examination the children underwent after arrival did not reveal lesions or stigmata that are characteristic of the disease in any cases&#44; and the syphilis serology test result was negative in all cases&#46; A treponema-specific test performed in 5&#8239;children aged &#60;1&#8239;year whose mothers had confirmed syphilis yielded a negative result&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Epidemiological and clinical studies performed by the Congenital Syphilis Investigation Team &#40;CSIT&#41; of the Russian Ministry of Health reported that in Russian pregnant women with active syphilis&#44; between 25&#37; and 64&#37; had a newborn with congenital syphilis&#46; They also found that in the case of pregnant women who did not undergo medical check-ups for their pregnancy or who had their first check-up late &#40;&#62;&#8239;28 weeks&#41; and did not receive treatment or received insufficient treatment or did not complete treatment&#44; the risk of congenital syphilis in the newborn was as high as 86&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> In Russia&#44; appropriate treatment of primary&#44; secondary&#44; and all forms of latent syphilis during pregnancy comprises administration of long-acting penicillin G benzathine&#44; as well as daily administration of short-acting penicillin G procaine&#46; Either of these 2 therapy regimens must be completed at least 30 days before delivery&#46; The regulations stipulate that only dermatologists and venereologists are authorized to treat pregnant women infected by syphilis&#44; although&#44; as a result of the recommendations of the CSIT&#44; national policy is beginning to be reformed&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> For a child to be diagnosed with congenital syphilis in Russia&#44; he&#47;she must have clinical symptoms or persistent serological abnormalities&#46; According to the CSIT&#44; these requirements may lead the frequency of the disease to be underestimated&#44; since they do not consider asymptomatic children&#44; i&#46;e&#46;&#44; the majority&#44; to be probable cases&#46; Most of these children were born to mothers with untreated or inadequately treated syphilis&#46; In any case&#44; health care policy stipulates that the children must receive preventive treatment with penicillin&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The prevalence of early and late congenital syphilis in children adopted from Russia is lower than 0&#46;05&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> thus indicating that they are well diagnosed&#44; treated&#44; and followed up in their country of origin&#46; In any case&#44; despite this low prevalence&#44; we consider it important to continue screening for syphilis after the child&#8217;s arrival in the country of adoption&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
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