Antenatal screening for hepatitis B infection and syphilis in the UK

Abstract

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.