Antenatal screening for HIV, hepatitis B, syphilis and rubella susceptibility in the EU/EEA : A Member State survey of policies and practices in the prevention of mother-to-child transmission
Savolainen-Kopra, Carita; Kontio, Mia; Mäkelä, Marjukka; Liitsola, Kirsi; Lindeman, Jukka; Isojärvi, Jaana; Surcel, Heljä-Maria; Davidkin, Irja; Brummer-Korvenkontio, Henrikki; Hiltunen-Back, Eija; Nohynek, Hanna; Leino, Tuija; Kuusi, Markku; Salminen, Mika (2016)
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Lataukset:
Savolainen-Kopra, Carita
Kontio, Mia
Mäkelä, Marjukka
Liitsola, Kirsi
Lindeman, Jukka
Isojärvi, Jaana
Surcel, Heljä-Maria
Davidkin, Irja
Brummer-Korvenkontio, Henrikki
Hiltunen-Back, Eija
Nohynek, Hanna
Leino, Tuija
Kuusi, Markku
Salminen, Mika
Editori
Croxford, Sara
European Centre for Disease Prevention and Control ECDC
2016
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi-fe201604049006
ECDC Technical Report
https://urn.fi/URN:NBN:fi-fe201604049006
ECDC Technical Report
Tiivistelmä
The results of this survey and the available surveillance data indicate that there is ongoing mother-to-child transmission of HIV, hepatitis B, syphilis and rubella, especially among certain high-risk populations. This suggests that the effectiveness of the antenatal screening practice – despite of considerable breaths – can be optimised. Factors that compromise effectiveness include low screening coverage, limited access to antenatal care services, and limited access to testing for several subpopulations.
While the case rates of MTCT of HIV and congenital syphilis are below the WHO global targets for the elimination in the EU/EEA (<50 cases per 100 000 live births), antenatal care coverage and testing still needs to be scaled up in several countries, with increased attention to be given to improving access to antenatal screening for vulnerable groups.
Few countries collect data robust enough for a comprehensive evaluation of antenatal screening programme effectiveness, and even fewer countries make the results of such evaluations publically available. It would therefore be helpful to develop a set of process and outcome indicators to guide countries in the monitoring and evaluation of antenatal screening programme effectiveness.
Several national surveillance systems in EU/EEA countries do not currently identify and record all MTCT cases in people born in the reporting country. Recording these cases is essential for the informative value of national screening programmes. In addition, the notification of congenital syphilis cases is not mandatory in some countries. Enhanced surveillance of MTCT cases with comprehensive collection of information about the mother and the child would improve the assessment of the incidence of MTCT and would provide valuable information on risk factors. This information could then be used to inform national policies and would probably lead to scaled-up antenatal screening for the most-at-risk subpopulations.
Ongoing mother-to-child transmission particularly affects certain vulnerable groups that are not adequately reached by, or do not have access to, testing services and prevention interventions that are available to the majority of the population. Member States should consider targeted interventions for such populations at risk, based on an assessment of disease epidemiology and risk profile.
ECDC is currently developing an evidence-based guidance to strengthen antenatal screening among vulnerable groups. The guidance will answer two central questions: a) What are the decisive elements of national programmes for antenatal infection screening with regard to their effectiveness and b) how can vulnerable groups be reached to increase the uptake of prenatal care in order to prevent or reduce mother-to-child transmission of infectious diseases.
While the case rates of MTCT of HIV and congenital syphilis are below the WHO global targets for the elimination in the EU/EEA (<50 cases per 100 000 live births), antenatal care coverage and testing still needs to be scaled up in several countries, with increased attention to be given to improving access to antenatal screening for vulnerable groups.
Few countries collect data robust enough for a comprehensive evaluation of antenatal screening programme effectiveness, and even fewer countries make the results of such evaluations publically available. It would therefore be helpful to develop a set of process and outcome indicators to guide countries in the monitoring and evaluation of antenatal screening programme effectiveness.
Several national surveillance systems in EU/EEA countries do not currently identify and record all MTCT cases in people born in the reporting country. Recording these cases is essential for the informative value of national screening programmes. In addition, the notification of congenital syphilis cases is not mandatory in some countries. Enhanced surveillance of MTCT cases with comprehensive collection of information about the mother and the child would improve the assessment of the incidence of MTCT and would provide valuable information on risk factors. This information could then be used to inform national policies and would probably lead to scaled-up antenatal screening for the most-at-risk subpopulations.
Ongoing mother-to-child transmission particularly affects certain vulnerable groups that are not adequately reached by, or do not have access to, testing services and prevention interventions that are available to the majority of the population. Member States should consider targeted interventions for such populations at risk, based on an assessment of disease epidemiology and risk profile.
ECDC is currently developing an evidence-based guidance to strengthen antenatal screening among vulnerable groups. The guidance will answer two central questions: a) What are the decisive elements of national programmes for antenatal infection screening with regard to their effectiveness and b) how can vulnerable groups be reached to increase the uptake of prenatal care in order to prevent or reduce mother-to-child transmission of infectious diseases.
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