Cuba was the first country in the world – and, as of August 2016, remained the only country in the Americas – to receive official validation from the World Health Organization for having eliminated mother-to-child transmission of both syphilis and HIV.
[Photo: A maternity home in Havana provides residential care for pregnant women with medical issues. Photo courtesy of Pan American Health Organization/World Health Organization]
Dr. Lola Virginia Stamm, associate professor of epidemiology at the UNC Gillings School of Global Public Health, has co-authored two commentaries that reflect on Cuba’s success as an example for future interventions.
One editorial, “The Cuban Experience in the Elimination of Mother-to-Child Transmission of Congenital Syphilis,” was published in the November 2016 issue of the American Journal of Public Health. The other commentary, titled “Elimination of Mother-To-Child Transmission of Syphilis in the Americas — A Goal That Must Not Slip Away,” was published online ahead of print as part of the January 2017 issue of Sexually Transmitted Diseases.
Mother-to-child transmission (MTCT) of syphilis – which can cause preterm birth, stillbirth, fetal/infant death and congenital infection – is preventable through universal screening for maternal syphilis during pregnancy. This screening ideally should occur in the first trimester, followed by treatment of infected women and their sexual partners with intramuscular benzathine penicillin G.
This screening and treatment plan is one pillar outlined by the World Health Organization (WHO) in its global initiative, implemented in 2007, to eliminate congenital syphilis. The other three pillars include ensuring sustained political commitment, increasing accessibility/quality of maternal and newborn health services, and establishing surveillance, monitoring and evaluation systems.
In a similar approach, in 2010, the Pan American Health Organization initiated a regional strategy for the Americas with the broader goal of the dual elimination of MTCT of both syphilis and HIV. This approach centers on integrating screening programs for both infections into routine prenatal care with a simple, cost-effective, finger-prick blood test that can be performed even in low-resource settings without traditional laboratories.
To receive validation that they have eliminated MTCT of both syphilis and HIV, countries must demonstrate – for at least one year – achievement of ≤50 cases of congenital syphilis and ≤30 cases of pediatric HIV per 100,000 live births.
Additionally, countries must provide at least two years of data showing that more than 95 percent of pregnant women attended at least one antenatal care visit, were screened for syphilis and HIV, received their test results, and – in the cases of women who screened positive – were adequately treated. These countries also are expected to maintain effective quality surveillance systems to monitor cases of MTCT of syphilis and HIV.
While the dual elimination of MTCT of syphilis and HIV is not an easy goal, Cuba’s success has shown that it is an attainable one. That Cuba achieved this major public health victory despite the country’s modest economic resources is attributable to a strong primary health-care infrastructure, well-connected data information systems, and a core of highly trained doctors and nurses who provide basic services to all, free of charge.
Currently, several other countries in the Americas are poised to eliminate MTCT of syphilis. With the Zika virus epidemic, however, low-income countries in the region face unanticipated challenges that could hinder efforts related to syphilis.
“It is imperative,” said Dr. Stamm, “that the commitment of these countries to the elimination of MTCT of syphilis be strengthened and sustained. We must ensure that this goal, which is almost within reach, does not slip away.”