{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:13:03Z","timestamp":1785906783536,"version":"3.56.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007188","name":"Uniformed Services University of the Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Congenital syphilis (CS) case rates have increased significantly in the United States over the past 20\u2009years, accelerating during the COVID-19 pandemic. Increasing rates may relate to access to care but have not been evaluated in a fully-insured population, such as the Military Health System.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We performed a repeated monthly cross-sectional study of CS cases and total encounters (care rates) using the queried Military Health System database. We defined CS by International Classifications of Diseases 10th Revision Clinical Modification diagnosis codes in beneficiaries \u2009\u2264\u20092\u2009years old. We evaluated pre-COVID-19 (March 2018 to February 2020), pandemic year 1 (March 2020 to February 2021), and pandemic year 2 (March 2021 to February 2022) periods. We performed change-point and trend analyses and Poisson regression to evaluate differences by sponsor rank, TRICARE region, and pandemic period. The Uniformed Services University Institutional Review Board approved the study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 69 unique CS cases were identified with a median monthly care rate of 0.90\/100,000 eligible beneficiaries. The CS care rate showed a 5.8% average monthly percent increase throughout the study period (P\u2009&amp;lt;\u2009.001) and a 20.8% average monthly percent increase in year 2 (P\u2009&amp;lt;\u2009.05). Compared to the pre-pandemic era, CS care rates increased in pandemic years 1 and 2 (adjusted rate ratio [aRR] 2.76 [95% CI: 1.95-3.92], 5.52 [95% CI: 4.05-7.53], respectively). Congenital syphilis care rates were lower in children of senior enlisted sponsors versus junior enlisted, aRR 0.24 (95% CI: 0.17-0.33), and higher in the West and North regions versus South, aRR 2.45 (95% CI: 1.71-3.53) and aRR 2.88 (95% CI: 2.01-4.12), respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Congenital syphilis care rates were substantially lower in this insured group than national rates but increased significantly during the COVID-19 pandemic. Higher care rates were seen in children of military members of lower rank. Regional trends differed from national data. These findings suggest that, even in a fully-insured population, income and regional differences impact CS, and the COVID-19 pandemic may have exacerbated differences in care delivery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae392","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T16:52:46Z","timestamp":1723654366000},"page":"e845-e850","source":"Crossref","is-referenced-by-count":2,"title":["Impact of the COVID-19 Pandemic on the Delivery of Congenital Syphilis Care in the Military Health System"],"prefix":"10.1093","volume":"190","author":[{"given":"Jennifer","family":"Teng","sequence":"first","affiliation":[{"name":"School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Prabhakar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]},{"name":"Henry M. Jackson Foundation , Bethesda, MD 20817,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(Ret.)","given":"Michael","family":"Rajnik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apryl","family":"Susi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]},{"name":"Henry M. Jackson Foundation , Bethesda, MD 20817,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Hisle-Gorman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cade M","family":"Nylund","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1615-4584","authenticated-orcid":false,"suffix":"(Ret.)","given":"Jill","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"issue":"suppl 24","key":"2025031111123184100_R1","first-page":"60","article-title":"The value of penicillin alone in the prevention and treatment of congenital syphilis","volume":"31","author":"Ingraham","year":"1950","journal-title":"Acta Derm Venereol Suppl (Stockh)"},{"issue":"3","key":"2025031111123184100_R2","doi-asserted-by":"publisher","DOI":"10.1016\/S2666-5247(22)00041-6","article-title":"Congenital syphilis increases in the USA","volume":"3","author":"Nelson","year":"2022","journal-title":"Lancet Microbe"},{"issue":"4","key":"2025031111123184100_R3","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1370\/afm.215","article-title":"Screening for syphilis infection: recommendation statement","volume":"2","author":"Calonge","year":"2004","journal-title":"Ann Fam Med"},{"key":"2025031111123184100_R4","article-title":"National Overview of STDs","author":"Centers for Disease Control and Prevention","year":"2022"},{"issue":"46","key":"2025031111123184100_R5","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.15585\/mmwr.mm7246e1","article-title":"Vital Signs: missed opportunities for preventing congenital syphilis \u2014 United States, 2022","volume":"72","author":"McDonald","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"2025031111123184100_R6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1097\/AOG.0000000000003000","article-title":"National trends and reported risk factors among pregnant women with syphilis in the United States, 2012\u20132016","volume":"133","author":"Trivedi","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"11","key":"2025031111123184100_R7","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1097\/INF.0000000000002445","article-title":"Incidence trends, risk factors, mortality and healthcare utilization in congenital syphilis-related hospitalizations in the United States","volume":"38","author":"Umapathi","year":"2019","journal-title":"Pediatr Infect Dis J"},{"issue":"12","key":"2025031111123184100_R8","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.33009","article-title":"Congenital syphilis epidemiology, prevention, and management in the United States: a 2022 update","volume":"14","author":"Fang","year":"2022","journal-title":"Cureus"},{"key":"2025031111123184100_R9","article-title":"Table\u00a033. Congenital Syphilis\u2014Reported Cases and Rates of Reported Cases by Year of Birth and Race\/Hispanic Ethnicity of Mother, United States, 2018\u20132022","author":"Centers for Disease Control Sexually Transmitted Infections Surveillance, 2022."},{"key":"2025031111123184100_R10","article-title":"Syphilis During Pregnancy","author":"Centers for Disease Control"},{"issue":"1","key":"2025031111123184100_R11","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/s0029-7844(98)00338-x","article-title":"Efficacy of treatment for syphilis in pregnancy","volume":"93","author":"Alexander","year":"1999","journal-title":"Obstet Gynecol"},{"issue":"22","key":"2025031111123184100_R12","doi-asserted-by":"publisher","first-page":"661","DOI":"10.15585\/mmwr.mm6922a1","article-title":"Missed opportunities for prevention of congenital syphilis\u2014United States, 2018","volume":"69","author":"Kimball","year":"2020","journal-title":"Morb Mortal Wkly Rep"},{"issue":"3","key":"2025031111123184100_R13","doi-asserted-by":"publisher","first-page":"63","DOI":"10.15585\/mmwr.mm7203a3","article-title":"Substance use among persons with syphilis during pregnancy \u2014 Arizona and Georgia, 2018\u20132021","volume":"72","author":"Carlson","year":"2023","journal-title":"Morb Mortal Wkly Rep"},{"issue":"Pt A","key":"2025031111123184100_R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.109150","article-title":"Alcohol and other substance use during the COVID-19 pandemic: a systematic review","volume":"229","author":"Roberts","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025031111123184100_R15","article-title":"Patients by Beneficiary Category","author":"Health.mil: MHS Home"},{"key":"2025031111123184100_R16","article-title":"Patient Care Numbers for the Military Health System","author":"Health.mil: MHS Home"},{"key":"2025031111123184100_R17","article-title":"The military-civilian gap: fewer family connections","author":"Pew Research Center"},{"key":"2025031111123184100_R18","article-title":"2020 Demographics: Profile of the Military Community","author":"Department of Defense"},{"key":"2025031111123184100_R19","article-title":"Military Pay Tables & Information","author":"Defense Finance and Accounting Service"},{"issue":"3","key":"2025031111123184100_R20","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1002\/(sici)1097-0258(20000215)19:3&lt;335::aid-sim336&gt;3.0.co;2-z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"2025031111123184100_R21","article-title":"Version 4.9.1.0\u2014April 2022; Statistical Methodology and Applications Branch, Surveillance Research Program","author":"Joinpoint Regression Program"},{"key":"2025031111123184100_R22","article-title":"Table\u00a032. 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