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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Una úlcera genital aguda no infecciosa para tener en cuenta en mujeres adultas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 528 "Ancho" => 805 "Tamanyo" => 140511 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lipschütz ulcer. Edema of the labia majora and multiple rounded ulcers with a fibrin base and a grayish halo distributed symmetrically on the labia majora. Note the typical symmetrical distribution (kissing ulcers).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. 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"apellidos" => "Roustan-Gullon" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173102030171X" "doi" => "10.1016/j.ad.2019.01.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173102030171X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219020301591?idApp=UINPBA000044" "url" => "/15782190/0000011100000007/v1_202009190930/S1578219020301591/v1_202009190930/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Prevalence of Syphilis in Children Adopted From Russia" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "623" "paginaFinal" => "624" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "G. Oliván-Gonzalvo" "autores" => array:1 [ 0 => array:3 [ "nombre" => "G." "apellidos" => "Oliván-Gonzalvo" "email" => array:1 [ 0 => "golivang@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centro de Pediatría y Adopción Internacional, Zaragoza, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de sífilis en niños adoptados de Rusia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1030 "Ancho" => 2092 "Tamanyo" => 198991 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incidence of syphilis in Russia (1995–2015). Source: Federal Statistics Service of the Russian Federation: Available at: <span class="elsevierStyleInterRef" id="intr0005" href="https://www.gks.ru">https://www.gks.ru</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The rapid social, political, 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. This was accompanied by a deterioration in the public health service, including prevention and control of sexually transmitted infections, which led to a dramatic increase in the frequency of syphilis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This increase was so pronounced that in 1996, the rate (254.2 cases per 100 000 inhabitants) was 48 times greater than in 1989. The disease mainly affected young women, and the number of reported cases of congenital syphilis multiplied 26-fold during the period 1991–1999 (from 8.04 per 100 000 to 209 per 100 000).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Rates have fallen since then,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> although the incidence has remained high (56.7 per 100 000 in 2005; 30.5 per 100 000 in 2010; 23.6 per 100 000 in 2015) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Russia is a key country for international adoption in Spain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the present investigation, we analyzed a cohort of children adopted from Russia to determine the prevalence of active maternal syphilis during pregnancy, congenital syphilis in children, and the results of serology testing for syphilis after arrival in Spain.</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 2000–2017 at the Center for Pediatrics and International Adoption (Centro de Pediatría y Adopción Internacional) in Zaragoza. The mean (SD) age was 31.3 (18.3) months, and 62.2% were boys. Similarly, we evaluated the preadoption medical reports from Russia. It is important to remember that the absence of a history of syphilis in the preadoption medical report does not rule the disease out.<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, all of the children underwent serology testing for syphilis (rapid plasma reagin or venereal disease research laboratory test). If the reagin tests are positive, then a treponema-specific test (fluorescent treponemal antibody absorption) is necessary for confirmation. This test is also performed in all children aged under 1 year when there is high clinical suspicion or confirmation that the biological mother had syphilis.<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% (n = 72) of the biological mothers had active syphilis during pregnancy and that at least 32% (n = 23) of children of a mother with active syphilis had congenital syphilis. 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, and the syphilis serology test result was negative in all cases. A treponema-specific test performed in 5 children aged <1 year whose mothers had confirmed syphilis yielded a negative result.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Epidemiological and clinical studies performed by the Congenital Syphilis Investigation Team (CSIT) of the Russian Ministry of Health reported that in Russian pregnant women with active syphilis, between 25% and 64% had a newborn with congenital syphilis. 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 (> 28 weeks) and did not receive treatment or received insufficient treatment or did not complete treatment, the risk of congenital syphilis in the newborn was as high as 86%.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> In Russia, appropriate treatment of primary, secondary, and all forms of latent syphilis during pregnancy comprises administration of long-acting penicillin G benzathine, as well as daily administration of short-acting penicillin G procaine. Either of these 2 therapy regimens must be completed at least 30 days before delivery. The regulations stipulate that only dermatologists and venereologists are authorized to treat pregnant women infected by syphilis, although, as a result of the recommendations of the CSIT, national policy is beginning to be reformed.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> For a child to be diagnosed with congenital syphilis in Russia, he/she must have clinical symptoms or persistent serological abnormalities. According to the CSIT, these requirements may lead the frequency of the disease to be underestimated, since they do not consider asymptomatic children, i.e., the majority, to be probable cases. Most of these children were born to mothers with untreated or inadequately treated syphilis. In any case, health care policy stipulates that the children must receive preventive treatment with penicillin.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</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 0.05%,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> thus indicating that they are well diagnosed, treated, and followed up in their country of origin. In any case, despite this low prevalence, we consider it important to continue screening for syphilis after the child’s arrival in the country of adoption.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Oliván-Gonzalvo G. Prevalencia de sífilis en niños adoptados de Rusia. Actas Dermosifiliogr. 2020;111:623–624.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1030 "Ancho" => 2092 "Tamanyo" => 198991 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incidence of syphilis in Russia (1995–2015). Source: Federal Statistics Service of the Russian Federation: Available at: <span class="elsevierStyleInterRef" id="intr0005" href="https://www.gks.ru">https://www.gks.ru</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The current state of health care in the Former Soviet Union: implications for health care policy and reform" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.D. Barr" 1 => "M.G. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 8 | 15 | 23 |
| 2024 Octubre | 89 | 60 | 149 |
| 2024 Septiembre | 89 | 26 | 115 |
| 2024 Agosto | 105 | 57 | 162 |
| 2024 Julio | 81 | 34 | 115 |
| 2024 Junio | 92 | 48 | 140 |
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| 2024 Marzo | 86 | 32 | 118 |
| 2024 Febrero | 74 | 44 | 118 |
| 2024 Enero | 72 | 34 | 106 |
| 2023 Diciembre | 98 | 13 | 111 |
| 2023 Noviembre | 70 | 34 | 104 |
| 2023 Octubre | 55 | 22 | 77 |
| 2023 Septiembre | 56 | 30 | 86 |
| 2023 Agosto | 33 | 9 | 42 |
| 2023 Julio | 42 | 43 | 85 |
| 2023 Junio | 57 | 25 | 82 |
| 2023 Mayo | 60 | 32 | 92 |
| 2023 Abril | 89 | 25 | 114 |
| 2023 Marzo | 54 | 26 | 80 |
| 2023 Febrero | 56 | 15 | 71 |
| 2023 Enero | 46 | 19 | 65 |
| 2022 Diciembre | 39 | 37 | 76 |
| 2022 Noviembre | 39 | 24 | 63 |
| 2022 Octubre | 60 | 19 | 79 |
| 2022 Septiembre | 44 | 46 | 90 |
| 2022 Agosto | 63 | 24 | 87 |
| 2022 Julio | 26 | 31 | 57 |
| 2022 Junio | 41 | 26 | 67 |
| 2022 Mayo | 62 | 42 | 104 |
| 2022 Abril | 52 | 23 | 75 |
| 2022 Marzo | 77 | 38 | 115 |
| 2022 Febrero | 54 | 18 | 72 |
| 2022 Enero | 63 | 29 | 92 |
| 2021 Diciembre | 54 | 39 | 93 |
| 2021 Noviembre | 62 | 43 | 105 |
| 2021 Octubre | 48 | 55 | 103 |
| 2021 Septiembre | 33 | 33 | 66 |
| 2021 Agosto | 38 | 28 | 66 |
| 2021 Julio | 43 | 35 | 78 |
| 2021 Junio | 32 | 18 | 50 |
| 2021 Mayo | 45 | 38 | 83 |
| 2021 Abril | 80 | 48 | 128 |
| 2021 Marzo | 55 | 32 | 87 |
| 2021 Febrero | 56 | 25 | 81 |
| 2021 Enero | 54 | 20 | 74 |
| 2020 Diciembre | 38 | 22 | 60 |
| 2020 Noviembre | 48 | 14 | 62 |
| 2020 Octubre | 53 | 14 | 67 |
| 2020 Septiembre | 48 | 39 | 87 |
| 2020 Agosto | 15 | 17 | 32 |
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