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      Antenatal screening for HIV, hepatitis B and syphilis in the Netherlands is effective

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          Abstract

          Background

          A screening programme for pregnant women has been in place since the 1950s in the Netherlands. In 2004 universal HIV screening according to opting out was implemented. Here, we describe the evaluation of the effectiveness of antenatal screening in the Netherlands for 2006-2008 for HIV, hepatitis B virus (HBV) and syphilis in preventing mother-to-child transmission, by using various data sources.

          Methods

          The results of antenatal screening (2006-2008) were compared with data from pregnant women and newborns from other data sources.

          Results

          Each year, around 185,000 pregnant women were screened for HIV, HBV and syphilis. Refusal rates for the screening tests were low, and were highest (0.2%) for HIV. The estimated annual prevalence of HIV among pregnant women was 0.05%.

          Prior to the introduction of screening, 5-10 children were born with HIV annually After the introduction of screening in 2004, only 4 children were born with HIV (an average of 1 per year). Two of these mothers had become pregnant prior to 2004; the third mother was HIV negative at screening and probably became infected after screening; the fourth mother's background was unknown. Congenital syphilis was diagnosed in fewer than 5 newborns annually and 5 children were infected with HBV. In 3 of these, the mothers were HBeAg positive (a marker for high infectivity). We estimated that 5-10 HIV, 50-75 HBV and 10 syphilis cases in newborns had been prevented annually as a result of screening.

          Conclusions

          The screening programme was effective in detecting HIV, HBV and syphilis in pregnant women and in preventing transmission to the child. Since the introduction of the HIV screening the number of children born with HIV has fallen dramatically.

          Previous publication

          [Translation from: 'Prenatale screening op hiv, hepatitis B en syphilis in Nederland effectief', published in 'The Dutch Journal of Medicine ' (NTVG, in Dutch)]

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          Most cited references 10

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          Mutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitis.

           M Omata,  T Ehata,  O Yokosuka (1991)
          The presence of the hepatitis B e antigen (HBeAg) in serum is known to be a marker of a high degree of viral infectivity. However, fulminant hepatitis may occur in persons who are negative for HBeAg. A single point mutation has been reported to produce a stop codon in the precore region of hepatitis B virus DNA and prevent the formation of the precore protein required to make HBeAg. To determine whether a precore-mutant virus is causally related to severe liver injury, we analyzed the entire precore region in viral strains isolated from patients with fatal cases and uncomplicated cases of hepatitis B. Serum was obtained from 9 patients with fatal hepatitis B (5 with fulminant and 4 with severe exacerbations of chronic hepatitis) and 10 patients with acute, self-limited hepatitis B. Serum samples from a sex partner implicated as the source of the virus in one case of fulminant hepatitis were also studied. The 87 nucleotides in the precore region of the hepatitis B virus were amplified by the polymerase chain reaction and then directly sequenced. Of the nine patients with fatal hepatitis, seven had retrievable hepatitis B DNA: In all seven there was a point mutation from G to A at nucleotide 1896 of the precore region, converting tryptophan (TGG) to a stop codon (TAG). In contrast, this mutation was not found in the 10 patients with acute, self-limited hepatitis B. The hepatitis B DNA from the implicated source contained a sequence with the stop-codon mutation that was identical to the sequence in her partner, who had fulminant hepatitis. The presence of a mutant viral strain is associated with and may be involved in the pathogenesis of fulminant hepatitis B and severe exacerbations of chronic hepatitis B.
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            The incidence of prenatal syphilis at the Boston City Hospital.

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              Comparison of a Treponema pallidum IgM immunoblot with a 19S fluorescent treponemal antibody absorption test for the diagnosis of congenital syphilis.

              We compared an in-house Treponema pallidum IgM immunoblot (IB) with a 19S fluorescent treponemal antibody absorption (IgM) test during routine use for the diagnosis of congenital syphilis (CS) in a national reference laboratory in a nonendemic setting. The overall agreement between the assays was high (97%), and 19S positive samples had at least 2 reactive bands in the IB. The high agreement is mainly caused by the large number of negative results (95%). If the 19S is taken as the gold standard, the estimate sensitivity of the IB was at least 88% with a specificity of 97.2%. Analysis of the discrepancies revealed that the IB was positive with 1 or 2 specific bands in 2.8% of the cases, whereas 19S was negative, possibly indicating higher sensitivity of the IB. We conclude that the IB is a sensitive method to detect contact with T. pallidum in neonates and can replace the 19S in routine laboratory screening for CS cases.
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                Author and article information

                Journal
                BMC Infect Dis
                BMC Infectious Diseases
                BioMed Central
                1471-2334
                2011
                30 June 2011
                : 11
                : 185
                Affiliations
                [1 ]Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
                [2 ]Stichting HIV Monitoring, Academic Medical Centre of the University of Amsterdam, the Netherlands
                [3 ]TNO quality of life, department of Prevention and Healthcare, Leiden, the Netherlands
                [4 ]Laboratory of Infectious Diseases and Perinatal Screening, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
                [5 ]Academic Medical Centre, department of gynaecology, University of Amsterdam, the Netherlands
                Article
                1471-2334-11-185
                10.1186/1471-2334-11-185
                3160399
                21718466
                Copyright ©2011 Op de Coul et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Infectious disease & Microbiology

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