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Antenatal screening for hepatitis B infection and syphilis in the UK
M L Newell1, C Thorne, L Pembrey
1Department of Epidemiology and Public Health, Institute of Child Health, London, UK.
Insights
UK antenatal screening for hepatitis B and syphilis lacks a clear national policy. Monitoring systems are needed to ensure equitable screening and vaccination coverage for pregnant women and newborns.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Maternal Health
Background:
- Antenatal screening for infectious diseases like hepatitis B and syphilis is crucial for preventing mother-to-child transmission.
- Existing UK policies for antenatal screening of hepatitis B and syphilis require assessment to ensure consistency and effectiveness.
Purpose of the Study:
- To evaluate current antenatal screening policies for hepatitis B and syphilis across the UK.
- To identify variations in policy and responsibility for ensuring vaccination uptake in infants exposed to hepatitis B virus.
Main Methods:
- A postal questionnaire survey was distributed to 192 obstetric units and 116 Public Health directorates in the UK.
- Data collected focused on antenatal screening policies for hepatitis B and syphilis, and the chain of responsibility for hepatitis B vaccination in newborns.
Main Results:
- 40% of obstetric centers offered universal hepatitis B virus testing; 24.1% of UK births occurred in these centers in 1996.
- Syphilis screening was common, but discontinuation was considered by some centers, despite higher prevalence in London.
- Responsibility for infant hepatitis B vaccination transfer was unclear, with only two areas monitoring full vaccination coverage.
Conclusions:
- A unified national policy is essential for equitable antenatal screening practices.
- Systems for monitoring local policy implementation and adherence are necessary to improve public health outcomes.
Objectives:
To assess antenatal hepatitis B and syphilis screening policies in the UK.
Design:
Postal questionnaire survey.
Setting:
One hundred and ninety-two obstetric units and 116 Public Health directorates.
Main Outcome Measures:
Antenatal screening policy and line of responsibility for ensuring vaccine uptake in hepatitis B virus exposed children.
Results:
Replies were received from 140 (73%) obstetric centres and 99 (85%) Public Health directors. Forty per cent of obstetric centres now offer hepatitis B virus tests to all pregnant women, and nearly one-quarter (24.1%) of all births in the UK in 1996 occurred in centres with a universal testing policy. The prevalence of chronic hepatitis B virus ranged from 0.3 to 17.5 per 1000 deliveries. Universal antenatal screening for serological evidence of syphilis was the norm, but five obstetric centres respondents and three Public Health directors were considering its discontinuation. In the nine London centres, syphilis prevalence was 2.06 per 1000 pregnant women, compared with 0.24 per 1000 elsewhere. Responses from Public Health directors indicated the nonspecific nature of the antenatal care contract. Responsibility for hepatitis B virus vaccination of the newly born infant rests with the hospital paediatrician, with transfer of responsibility to the community usually occurring through a discharge letter. Only two areas had a monitoring system to ensure full hepatitis B virus vaccination coverage of exposed infants.
Conclusions:
If antenatal screening policies are to be equitable there is a need for a clear national policy, and systems need to be established to monitor local policy and practice.
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