No 34 - 2019  

Parents will soon start receiving reminders before the planned vaccination time
Syphilis 2018

Parents will soon start receiving reminders before the planned vaccination time

This autumn, Statens Serum Institut in collaboration with the Danish Health Data Authority will launch a new childhood vaccination reminder scheme.

As from 15 May 2014, the SSI has sent out reminders to parents about childhood vaccinations if a child has not received one or more of the vaccinations recommended under the childhood vaccination programme when he or she turns 2, 6½ or 14 years old. This scheme has contributed to increasing the vaccination coverage and hence ensured that as many children as possible avoid serious diseases that may be prevented through vaccination.

Soon, parents will start receiving reminders both when a vaccination is upcoming, and if the planned vaccination time has passed. The objective of the scheme is to ensure that even more children are vaccinated timely.

The following children will be comprised by the new reminder scheme:

  • Children born after 1 August 2019.
  • Children who turn 4 years old as from 1 November 2019.
  • Children who turn 12 years old as from 1 November 2019.

In the Danish Vaccination Register (DVR), these children will be comprised by the childhood vaccination programme relevant for their age, thereby following a “recommended vaccination programme”.

Two weeks before the scheduled time of any childhood vaccination, the parents will receive an e-Boks message reminding them to schedule an appointment for childhood vaccination. Furthermore, one month after the planned vaccination time, automatic follow-up will check if the vaccination was, in fact, given. If a vaccination has not been registered in the DVR, a reminder about lacking childhood vaccination will be sent to the parents. The first reminders will be sent out by mid October 2019. In the longer term, parents will also have the opportunity to receive vaccination reminders by NemSMS.

Children who are not comprised by the new scheme will continue to receive the reminders sent out under the previous reminder scheme from 2014.

For more information about the two reminder schemes, please see here. (in Danish). On the link and related pages you will find sample reminder letters, information about registration of vaccines as a vaccination course and about how parents may opt out of receiving the reminders.

(T.G. Krause and L.K. Knudsen, Department of Infectious Disease Epidemiology and Prevention)

Syphilis 2018

  • Syphilis has followed an increasing trend since the turn of the millennium, but now seems to be stagnating for heterosexually infected women and men, and decreasing for men who have sex with men (MSM). In 2018, a total of 526 cases were recorded of whom 84% were men.
  • The majority of cases occurred in MSM of whom 23% were HIV positives.
  • Unlike gonorrhoea, which occurs more frequently in 20-24-year-olds, syphilis is more frequent among somewhat older persons; in 2018, the median age was 39 years for men and 29 years for women.
  • Among the 82 women who were diagnosed with syphilis in 2018, 21 (26%) were detected owing to the general pregnancy screening. This indicates that an undiagnosed share may exist among women and probably also among heterosexual men. No cases of congenital syphilis were notified during 2018.
  • Frequent testing of relevant groups can help break infection chains and thus contribute to reducing the number of cases.
  • All MSM are recommended annual testing for HIV and other sexually transmittable infections. MSM who lead an active sex life and who do not always use a condom are recommended testing 2-4 times annually.

In 2018, Statens Serum Institut (SSI) recorded 526 syphilis cases in 524 persons. 

A total of 444 (84%) of the cases occurred in 442 men and 82 (16%) in 82 women, as two men each had two cases in the course of the year.

For a detailed epidemiological description of the 2018 occurrence, please see the 2018 annual report on syphilis.

In 1994-2001, syphilis was very rare in Denmark; the period saw less than 20 notified cases per year. As from the turn of the millennium, an increase has been observed in the number of cases. This increase was particularly pronounced in the 2006-2011 period. Following a decrease in the number of cases in 2012, the number of syphilis cases followed an increasing trend, but now the number of cases has once again decreased. The recorded decrease, however, was observed among MSM only.

Among the 82 women who were diagnosed with syphilis in 2018, 21 (26%) were detected owing to the general pregnancy screening. This seems to indicate that an undiagnosed share exists among heterosexuals who are not tested because they are symptom-free. Even though heterosexual men and women do not belong to the groups that should regularly undergo syphilis testing because they only account for a limited share of those infected, syphilis today needs to form part of the differential diagnostic considerations when relevant symptoms are observed, and syphilis testing should be considered more frequently than was previously the case.

The typical chancre is symptom-free and furthermore often localised to places where it goes undetected by the patient (vagina, rectum, oral cavity). Interruption of chains of infection therefore cannot be based on visits to the physician triggered by symptoms. Therefore, it is essential that MSM are tested frequently, even if they have no symptoms. This leads to the diagnosis and treatment of otherwise unacknowledged syphilis, whereby infection chains can be broken.

Campaigns have been run to motivate more MSM to undergo frequent testing for sexually transmittable infections, including HIV, syphilis and gonorrhoea. These campaigns now seem to have had a positive effect on syphilis, as a decrease is observed among MSM. We hope that the offer of PrEP (medication-based HIV prophylaxis, Pre-exposure Prophylaxis), which was introduced in 2019, will mean that even more MSM are tested frequently for syphilis, among others, whereby infection chains will be broken more often.

All MSM are recommended annual testing for sexually transmittable infections, including HIV, and MSM who lead an active sex life and who do not always use a condom are recommended testing 2-4 times annually. This test frequency is also recommended by the US Centers for Disease Control and Prevention (CDC) and the National Health Service (NHS) in the UK.

Since 1 January 2010, the general screening of pregnant women has included syphilis, EPI-NEWS 27-33/2010. In case of a positive screening test, confirmatory serological tests need to be made to confirm or refute the screening result. In several cases, it has been necessary to remind the patient’s GP about this, and in some cases syphilis that obviously needed treatment was detected through confirmative tests in these women.

PCR testing is expedient for detection of Treponema pallidum in chancre material and is often positive approx. 14 days before any antibodies can be detected. Even so, serological testing also needs to be performed in order to monitor treatment effect.

Syphilis is notified to the Department of Infectious Disease Epidemiology and Prevention, SSI, on Form 1510, which is available for download here.

(S. Cowan, A.K. Hvass, Department of Infectious Disease Epidemiology and Prevention, K.D. Bjerre, the Data Integration and Analysis Secretariat, S. Hoffmann, Department of Bacteria, Parasites & Fungi)