WHO method for estimating congenital syphilis to inform surveillance and service provision, Paraguay (vol 100, pg 231, 2022)

Problem In Paraguay, incomplete surveillance data resulted in the burden of congenital syphilis being underestimated, which, in turn, led to missed opportunities for infant diagnosis and treatment. Approach The incidence of congenital syphilis, as defined by the World Health Organization (WHO), was estimated for Paraguay using the WHO congenital syphilis estimation tool. This tool was also used to monitor progress towards the elimination of mother-to-child transmission of syphilis. Local setting The burden of syphilis in Paraguay has historically been high: its prevalence in pregnant women was estimated to be 3% in 2018. Relevant changes The incidence rate of congenital syphilis estimated using the WHO tool was around nine times the reported incidence. Subsequently, Paraguay: (i) provided training to improve diagnosis and case reporting; (ii) strengthened information systems for case monitoring and reporting; and (iii) procured additional rapid dual HIV-syphilis and rapid plasma reagin tests to increase syphilis testing capacity. In addition, the Ministry of Health prepared a new national plan for eliminating mother-to-child transmission of syphilis, with clear monitoring milestones. Lessons learnt Health-care providers'reporting and surveillance procedures for congenital syphilis may not adequately reflect national and international casedefinitions. Use oftheWHOcongenital syphilis estimation tool in Paraguay drew attention to congenital syphilis as a national public health problem and highlighted the importance ofcomprehensive national surveillance systems and accuratedata. Ongoing use oftheWHOtool can trackprogresstowardsthe elimination ofmother-to-child transmission ofsyphilis byhelping improve syphilis service coverage and national surveillance.