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Congenital syphilis (CS) in infants younger than 1 year increased 23% from 2005 to 2008 in the U.S., primarily in the South among blacks. Among the mothers in the 431 cases reported in 2008, 29% did not receive prenatal care; of the 276 who did receive prenatal care, 27% were screened <30 days before delivery (which does not leave time for sufficient treatment), and 24% screened positive >30 days before delivery but received no treatment. The Centers for Disease Control (CDC) recommends serologic screening of all pregnant women at the first prenatal visit, and for those at high risk for syphilis, repeat screening at 28 weeks' gestation and at delivery. The case fatality in these 431 infants was 6.5%.