Antenatal screening for HIV, hepatitis B, syphilis and rubella susceptibility in the EU/EEA
The results of this survey among national public health experts indicate that limited access to antenatal care services, combined with low testing uptake among pregnant women in certain subpopulations, often leads to low screening coverage for HIV, hepatitis B, syphilis and rubella susceptibility, especially in vulnerable groups.
Annually, more than 5 million live births are recorded in the EU. Antenatal screening for HIV, hepatitis B, syphilis and rubella susceptibility is widely implemented in the EU/EEA, most commonly with opt-out testing policies followed by universal screening during pregnancy. But despite availability of effective preventive interventions, transmission of infections with HIV, hepatitis B, syphilis or rubella from mother to child before and during birth as well as in infancy still occur across Europe.In the vast majority of EU/EEA countries (96%), the provision of antenatal care to pregnant women is based on national guidance, screening recommendations or a prevention strategy. In 2011, the global community defined the elimination of mother-to-child transmission (MTCT) of HIV and syphilis as a public health priority. Responses from 26 EU/EEA countries that answered to an ECDC survey in 2013 showed that they had either reached, or were very close to reaching, the targets for the elimination of MTCT of HIV and syphilis. However, mother-to-child transmission is still reported in several European countries. In addition, few countries collect the data needed to document performance of antenatal screening programmes.
The survey results, published in a new ECDC report, indicate that reasons for on-going MTCT of these infections in Europe could be that effective antenatal screening strategies are compromised by incomplete screening coverage, poor access to antenatal care, or inadequate HIV, syphilis and hepatitis testing among women among groups at high risk. These groups include migrants from high prevalence countries, women exercising high risk behaviours (e.g. women who inject drugs), women who are tested late in the course of their pregnancy or those without access to antenatal care.
In reaction to these findings, ECDC is currently developing evidence-based guidance to help Member States strengthen antenatal screening among vulnerable groups. The guidance will look at which elements of a national antenatal screening programme for infections influence effectiveness, and which are the specific approaches to be used for reaching the vulnerable groups in order to increase the uptake of prenatal care and reduce/prevent MTCT.
Why test for infections during pregnancy
Mother-to-child transmission is the most predominant mode of HIV infection in children worldwide. Without intervention, the risk of HIV transmission from an infected mother to her child ranges from 15% to 30% during pregnancy/delivery to between 10% and 20% during breastfeeding. This risk can be reduced to 1 to 2% with a combination of appropriate antenatal interventions including anti-retroviral therapy (ART) for the mother, anti-retroviral prophylaxis for the newborn, and avoidance of breastfeeding.
Transmission of hepatitis B from mother to child is preventable in 95% of all cases through the administration of vaccine and immunoglobulin to the baby at birth. With no immunoprophylaxis, more than 90% of infants infected by their positive mothers will go on to develop chronic infection.
There is no treatment for rubella but MTCT can be prevented by ensuring that all women who plan to get pregnant are immune or have been immunised against rubella.
HIV Continuum of care: Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia (2020 progress report)
16 Aug 2021 - In 2020, using data from countries able to provide at least two consecutive stages of the continuum, the overall performance of the European and Central Asian region against the global 90-90-90 targets is 82% of all PLHIV with HIV diagnosed, 67% of those diagnosed with HIV on treatment and 90% of those on treatment virally suppressed. More progress is needed to meet the substantive target of 73% of all PLHIV being virally suppressed, with performance for the overall region at 50% (based on the countries that submitted data for all four stages of the continuum).
The sustainable development goals and hepatitis B and C in the EU/EEA
29 Mar 2021 - In order to monitor progress towards the United Nations Sustainable Development Goals 2030 target to combat viral hepatitis, this report provides data on hepatitis B and C prevention, incidence, diagnosis, treatment, cure/viral suppression, and mortality in European Union/European Economic Area (EU/EEA) countries with data collected in 2019.
Hepatitis B and C testing in the EU/EEA: progress in reaching the elimination targets
26 Mar 2021 - This brief will present a snapshot of hepatitis B and C testing in the European Union/European Economic Area (EU/EEA), discussing progress made towards the European action plan 2020 testing target, focussing on key populations and settings for testing, barriers to testing, and testing policies.