Syphilis cases in babies skyrocket in Canada due to healthcare failures

TORONTO, March 31 (Reuters) – The number of babies born with syphilis in Canada is rising at a much faster rate than in the United States or Europe, a rise public health experts say is due to rising methamphetamine use and lack of access to the public health system for Aboriginal people.

While syphilis has made a global resurgence over the past five years, Canada is an outlier among wealthy nations in its rate of increase: 13 times in five years, according to Health Canada. The incidence of babies born with syphilis reached 26 per 100,000 live births in 2021, the most recent year available, up from 2 in 2017, according to Health Canada data.

That total is expected to rise further in 2022, according to preliminary government data obtained by Reuters.

According to the World Health Organization (WHO), babies with congenital syphilis are at higher risk of low birth weight, bone malformations and sensory difficulties.

Syphilis in pregnancy is the second leading cause of stillbirth worldwide, according to WHO.

Yet congenital syphilis is easily preventable if an infected person has access to penicillin during pregnancy.

Among the wealthiest group of G7 countries for which data is available, only the United States had a higher incidence of syphilis at birth: 74 per 100,000 live births in 2021, triple the rate in 2017, according to preliminary figures from the United States Centers for Disease. Control and Prevention (CDC).

There were 2,677 cases of congenital syphilis in the United States in 2021 for a population of 332 million, according to preliminary CDC data. Canada had 96 cases for a population of 38 million, according to Health Canada.

People experiencing poverty, homelessness and substance abuse, and those without access to the healthcare system, are more likely to contract syphilis through unprotected sex and pass it on to their babies, said public health researchers.

“In high-income countries, you see it in pockets of poor populations,” said Teodora Elvira Wi, who works in WHO’s HIV, hepatitis and sexually transmitted infections programme.

“It’s a marker of inequality. It’s a marker of poor quality prenatal care.”

What sets Canada apart are its indigenous populations who face discrimination and often have limited access to health and social services, said Sean Rourke, a scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto. , which focuses on the prevention of sexually transmitted diseases. disease.

“It’s just the whole system and all the things that we’ve done the wrong way to not support Indigenous communities,” he said.

Health Canada told Reuters it had dispatched epidemiologists to help provinces contain the rise in congenital syphilis. Spokesman Joshua Coke said the federal government is expanding access to testing and treatment in Indigenous communities.

Tessa, a 28-year-old Indigenous woman who asked to be identified only by her middle name, said she had been addicted to crystal meth for years and was homeless when she became pregnant in Saskatoon, in Saskatchewan.

“I would walk down the street crying, ‘Why am I living like this?'” she told Reuters.

She said she received no prenatal care until she gave birth in November, when she tested positive for HIV and syphilis in a routine test.

Her daughter was prescribed a 10-day course of antibiotics, given by IV, and is now healthy, Tessa said. But she still thinks about the difficulties she encountered in accessing prenatal care.

“Having transportation, maybe, and a place to live, and being sober, would probably have helped a lot,” she said.

Susanne Nicolay, head nurse at the Wellness Wheel Clinic in Regina, Saskatchewan, which serves Indigenous and vulnerable populations, said providers need to do more to expand access to health care. “The system always talks about hard-to-reach patients. But I think it’s the healthcare providers who are hard to reach,” she said.

“MULTIPLE CHESS”

A lot has to go wrong for a baby to be born with syphilis, said Jared Bullard, a Manitoba pediatrician who has been studying babies born with syphilis since 2021 in an ongoing study for the Public Health Agency of Canada. .

“It points to multiple failures along the way,” he said.

In Canada, the increase in the number of babies born with syphilis is concentrated in the three prairie provinces: Manitoba, Saskatchewan and Alberta.

The Prairie provinces have higher crystal meth use and remote and Indigenous populations who may have difficulty accessing health care, Bullard said.

Manitoba has had the highest rate, with around 371 cases per 100,000 live births in 2021.

The province said in an emailed statement that it is expanding training for health care providers on controlling sexually transmitted infections, encouraging frequent testing and early treatment. He scans his STI infection records.

Saskatchewan has launched a public awareness campaign urging people to practice safer sex and get tested, said Dale Hunter, spokesman for the provincial health department. The province recorded an incidence of 185 cases of congenital syphilis per 100,000 live births in 2021.

Alberta said women aged 15 to 29 accounted for more than half of what it called a “significant increase” in syphilis rates. “The reasons for the increase are not fully known, but it is likely that various factors contributed to this increase,” Alberta Health Services spokesman James Wood said.

In preliminary results of a study of 165 infants exposed to syphilis, Bullard and fellow pediatrician Carsten Krueger found that at least two-thirds were born to women reporting a history of substance abuse.

About 45% of women identified as Aboriginal and 40% had no recorded ethnicity. Aboriginal people make up about 5% of the Canadian population, according to census data.

About a quarter of people in the study were not tested because they did not receive prenatal care; about a fifth of those who tested positive were not treated. Bullard said he’s also seen people seek treatment early in pregnancy and then get re-infected.

Public health researchers and clinicians said rates of congenital syphilis began to rise before the pandemic and worsened as public health agencies diverted resources to COVID-19 testing and other prevention measures. health related to the pandemic.

“All the social circumstances that contributed to this are only getting worse during the pandemic,” said Ameeta Singh, an infectious disease specialist with an HIV/STI practice in Edmonton, Alta.

This month, Health Canada approved a test for syphilis and HIV that can provide results in less than a minute, allowing providers to begin treatment immediately.

Some researchers and public health providers are urging the Canadian government to purchase and distribute the tests.

“We probably need a million tests to move around the country,” Rourke said. “The solution is right in front of us.”

Health Canada did not respond when asked about purchasing test kits.

Reporting by Anna Mehler Paperny Editing by Denny Thomas and Suzanne Goldenberg

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