TORONTO, March 31 (Reuters) – The number of babies born with syphilis in Canada is rising faster than that recorded in the United States or Europe, a rise that public health experts say is driven by of methamphetamine use and lack of access to the public health system for Indigenous people.
While syphilis has made a global resurgence in the past five years, Canada is an outlier among rich countries in its rate of increase: 13-fold in five years, according to Health Canada. The incidence of babies born with syphilis rose to 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 on track to increase further by 2022, according to preliminary government data obtained by Reuters.
Babies with congenital syphilis are at increased risk of low birthweight, bone malformations and sensory difficulties, according to the World Health Organization (WHO).
Syphilis in pregnancy is the second leading cause of childbirth worldwide, WHO said.
But congenital syphilis is easily preventable if an infected person gets access to penicillin during their pregnancy.
Among the G7 group of richer countries for which data is available, only the United States has a higher incidence of syphilis at birth: 74 per 100,000 live births in 2021, triple the rate in 2017, according to preliminary estimates as from the US Centers for Disease Control and Prevention (CDC).
There were 2,677 cases of congenital syphilis in the US in 2021 for a population of 332 million, according to preliminary CDC data. Canada has 96 cases for a population of 38 million, according to Health Canada.
People experiencing poverty, homelessness and drug use, and those with inadequate access to the health system, are more likely to contract syphilis through unprotected sex and pass it on to their babies, public health researchers said.
“In high-income countries, you see it in pockets of poor populations,” said Teodora Elvira Wi, who works in the WHO’s HIV, Hepatitis and sexually transmitted infection program.
“It’s a marker of inequality. It’s a marker of low-quality prenatal care.”
What sets Canada apart is that its Indigenous population experiences discrimination and often has poor access to health and social services, said Sean Rourke, a scientist at the Li Ka Shing Knowledge Institute in St. Michael’s Hospital in Toronto, which focuses on the prevention of sexually transmitted diseases.
“It’s just the whole system, and all the things we’ve done in a bad way to not support indigenous communities,” he said.
Health Canada told Reuters it has sent epidemiologists to help provinces curb the rise in congenital syphilis. Spokesperson Joshua Coke said the federal government is expanding testing and treatment access to indigenous communities.
Tessa, a 28-year-old Indigenous woman who asked to be identified only by her middle name, said she had a years-long addiction to crystal meth and was homeless when she became pregnant in Saskatoon, Saskatchewan.
“I would walk down the street crying: ‘Why am I living like this?'” he told Reuters.
She said she received no prenatal care until she gave birth in November, when she tested positive for HIV and syphilis during a routine test.
Her daughter was prescribed a 10-day course of antibiotics, administered by IV, and is now healthy, Tessa said. But she still thinks about the difficulties she experienced accessing prenatal care.
“Having transportation, maybe, and a place to live, and being sober, maybe helped, big time,” he said.
Susanne Nicolay, nurse lead 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 patients who are hard to reach. But I think it’s health providers who are hard to reach,” he said.
A lot has to go wrong for a baby to be born with syphilis, said Jared Bullard, a Manitoba pediatrician who has been researching babies born with syphilis since 2021 in an ongoing study for the Public Health Agency of Canada.
“It points to a lot of failures down the road,” he said.
In Canada, the increase in babies born with syphilis is concentrated in three prairie provinces: Manitoba, Saskatchewan and Alberta.
Prairie provinces have higher use of crystal meth and remote populations and indigenous populations who may have trouble accessing health care, Bullard said.
Manitoba recorded the highest rate, with about 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 in addressing sexually transmitted infections, encouraging frequent testing and early treatment. It is digitizing its records of STI infections.
Saskatchewan has launched a public awareness campaign urging people to practice safe sex and get tested, said Dale Hunter, a spokesman for the province’s health ministry. The province had an incidence of 185 cases of congenital syphilis per 100,00 live births in 2021.
Alberta says women ages 15-29 account for more than half of what it calls a “significant increase” in syphilis rates. “The reasons for the increase are not fully known, but it is likely that a variety of factors contributed to this increase,” said Alberta Health Services spokesperson James Wood.
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 sexual abuse. ingredient.
About 45% of women identified as Indigenous and another 40% had no recorded ethnicity. Indigenous people make up about 5% of Canada’s population, according to census data.
About a quarter of the people in the study didn’t get tested because they didn’t get prenatal care; approximately one-fifth of those who test positive are untreated. Bullard said she’s also seen people treated early in pregnancy and then reinfected.
Public health researchers and clinicians say rates of congenital syphilis began to rise before the pandemic and worsened as public health agencies diverted resources to testing for COVID-19 and other related health measures. in the pandemic.
“All the social conditions that contributed to this have only gotten worse in the pandemic,” says Ameeta Singh, an infectious disease specialist with an HIV/STI practice in Edmonton, Alberta.
This month Health Canada approved a syphilis and HIV test that can provide results in less than a minute, allowing providers to start 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 get out there nationwide,” Rourke said. “The solution is right in front of us.”
Health Canada did not respond when asked about the purchase of test kits.
Reporting by Anna Mehler Paperny Editing by Denny Thomas and Suzanne Goldenberg
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