pathogens Article High Incidence of Congenital Syphilis after Implementation of the Brazilian Ministry of Health Ordinances Related to Maternal Diagnostics Ítala Santos Veras 1 , Caroline Alves Feitosa 1 , Amâncio José de Souza 1 , Leila Carvalho Campos 2 , Galileu Barbosa Costa 3, * ,† and Viviane Matos Ferreira 1,2, * ,†   Citation: Veras, Í.S.; Feitosa, C.A.; de Souza, A.J.; Campos, L.C.; Barbosa Costa, G.; Ferreira, V.M. High Incidence of Congenital Syphilis after Implementation of the Brazilian Ministry of Health Ordinances Related to Maternal Diagnostics. Pathogens 2021, 10, 606. https:// doi.org/10.3390/pathogens10050606 Academic Editor: Despina G. Contopoulos-Ioannidis Received: 14 April 2021 Accepted: 12 May 2021 Published: 15 May 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia 40290-000, Brazil; italasveras@gmail.com (Í.S.V.); feitosacaroline@gmail.com (C.A.F.); amancio.souza@gmail.com (A.J.d.S.) 2 Laboratório de Patologia e Biologia Molecular, Instituto Gonçalo Moniz, Fiocruz, Bahia 40296-710, Brazil; leila.campos@fiocruz.br 3 Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Federal District 70723-040, Brazil * Correspondence: galileu.costa@saude.gov.br or galileuk1@gmail.com (G.B.C.); vivianeferreira@bahiana.edu.br (V.M.F.); Tel.: +55-6133157708 (G.B.C.); +55-7132768217 (V.M.F.) † These authors share the senior authorship. Abstract: The increasing rates of maternal and congenital syphilis (CS) infections are public health concerns and need further investigation in order to provide better assistance in epidemiological surveillance and new strategies for the assistance and prevention of CS. In December 2011, the Brazilian Ministry of Health (BMH) implemented ordinance number 3.242, reinforced in 2012 by ordinance number 77, aiming to improve the quality of the syphilis diagnosis system using rapid tests. Here, we evaluate the incidence, lethality, and possible factors associated with CS in Salvador, Bahia, in the pre-resolution period (2007 to 2011) and post-resolution (2012 to 2016). An observational, ecological time-series study is conducted using secondary data collected from the National Notifiable Diseases Information System (SINAN). Linear regression analysis to estimate increases or reductions in the mean incidence over time is also performed. A total of 5470 CS cases are analyzed. The incidence ranges from 2.1 cases per 1000 live births in 2007 to 17.1 cases per 1000 live births in 2019, showing a progressive increase in incidence over the years and reduction of lethality in the post- resolution period. The number of CS cases reported prior to the implementation of the ordinances (2007–2011) does not reveal a significant increase in the incidence. However, in the post-ordinances period (2012–2019), there is an average increase of the number of CS cases by three times over the years, with an average increase of 1.8 new cases annually. Our findings highlight the importance of diagnosis and support information in strategies for CS prevention. Furthermore, these data show a positive impact of resolutions on the diagnosis and evolution of the disease. Keywords: congenital syphilis; incidence; diagnostics; mother-to-child transmission; public health; surveillance; Ministry of Health 1. Introduction Mother-to-child transmission of syphilis has been considered a global public health burden since the 15th century, and approximately 1.5% of pregnant women (more than two million) develop clinical syphilis every year worldwide [1,2]. The absence of adequate treatment of pregnant women diagnosed with syphilis can cause spontaneous abortion, stillbirth, and early infant death; about 80% of affected pregnancies result in adverse outcomes [3,4]. Congenital syphilis (CS) is a consequence of the hematogenous dissemination of Treponema pallidum through the placenta from infected untreated or inappropriately treated pregnant women [5]. In the early stages of the disease, pregnant women are more Pathogens 2021, 10, 606. https://doi.org/10.3390/pathogens10050606 https://www.mdpi.com/journal/pathogens