Eurosurveillance - Volume 14, Issue 9, 05 March 2009

Epidemiological data on the prevalence of serological markers of hepatitis B virus (HBV) infection in pregnant women in Greece are limited. We evaluated the prevalence of HBV serological markers in a multinational population of pregnant women in Athens, Greece. The overall prevalence of hepatitis B surface antigen (HbsAg) was 4.1% with the highest rates among Albanian immigrants (12%). Relatively low vaccination-induced protection rates (32.5%) were observed, a finding suggesting that surveillance and immunisation programmes targeted at pregnant women are necessary.

In the United Kingdom (UK), it is recommended to universally offer antenatal infection screening for human immunodeficiency virus (HIV), hepatitis B and syphilis infections, and susceptibility to rubella for the benefit of the mother and to reduce vertical transmission of infection. This paper describes the surveillance of antenatal infection including uptake of screening, and the results of testing in pregnant women in London between 2000 and 2007. Antenatal screening coordinators in liaison with midwifery heads and microbiologists at all thirty London National Health Service (NHS) Trust maternity units supplied quarterly data on the number of pregnant women booked for antenatal care, tests done, and tests results. The overall estimated uptake of screening increased since 2000 and reached 95.6% for HIV, 96.5% for syphilis, 96.2% for hepatitis B and 97% for rubella susceptibility by the second half of 2007. There is considerable variation in the performance between NHS Trusts. The overall estimated prevalence of HIV infection was 3.4/1,000 women (ranging from <1/1,000 to 10/1,000 across Trusts), of hepatitis B (HBsAg-positive) was 11.3/1,000 (2.6/1,000- 23.9/1,000), of syphilis was 4.4/1,000 (<1/1,000-16.3/1,000) and of rubella susceptibility was 39.3/1,000 (19-103/1,000). Antenatal infection screening has improved and there has been some success in implementation of national policy. However, screening uptake and prevalence of infection vary considerably across London NHS Trusts and some women are evidently disadvantaged. Improvements in information systems should help local partners to focus their interventions in those Trusts where work is still needed to increase testing as well as the capacity to monitor the uptake of screening.

Human cytomegalovirus (HCMV) is considered the most frequent cause of congenital infection, occurring in 0.2 to 2.2% of all live births. Since this is a wide range of prevalences observed in different studies, it would be desirable to investigate the prevalence of this infection at national level. The aim of this study was the evaluation of the national prevalence of HCMV congenital infection. We analysed a total of 3,600 Guthrie cards collected from Portuguese newborns during a period of 14 months (August 2003 to September 2004). The cards covered all regions of Portugal and were proportional to the number of births in each region. A heat DNA extraction method was used, followed by DNA amplification by nested PCR. Sensitivity and specificity of this method were evaluated as 93% and 100%, respectively, using 28 cards from HCMV-positive and 280 cards from HCMV-negative children. The national prevalence of congenital HCMV was determined as 1.05% (95% confidence interval: 0.748-1.446). This is the first study of the prevalence of HCMV congenital infection at national level in Portugal. It suggests that Portugal may have one of the highest prevalences of congenital HCMV infection in Europe.

Rubella and varicella zoster virus (VZV) infections during pregnancy can cause severe adverse outcomes in the embryo or foetus. Despite the availability of safe and efficacious vaccines, cases of congenital rubella and varicella syndrome still occur in Europe. As of 2004, several countries had high proportions of women of childbearing age that were susceptible to rubella and varicella virus infection. Effective immunisation strategies to enhance prevention should include an active role of different medical specialists in order to include all medical consultations a person may have at different points in their lives as an opportunity to immunise susceptibles. Linkage of data on infectious diseases with those from congenital defects registries may be helpful to monitor the epidemiology of congenital rubella and varicella.

Monthly serological testing is mandatory in France for pregnant women not immune to toxoplasmosis. We assessed for the first time the adherence to this national programme, using data from antenatal tests for Toxoplasma antibodies collected by the Union of Health Insurance Services in the French Rhone-Alpes region. Data from 34,290 pregnancies was analysed. The first test was done late in 25% of women (8,430). Women had on average 5.7 tests during pregnancy, only 40 percent (13,774) were tested seven or more times as recommended. Young women were more likely to have a late first test, but age did not significantly influence regularity and number of tests. Free medical coverage favoured a late first test, fewer tests and longer between-test intervals. An early first test did not affect test numbers or between-test intervals. A re-useable prescription for several tests was associated with better adherence. Prescription by general practitioners was associated with an earlier first test, but fewer tests and longer between-test intervals. When prescribing physician(s) included a gynaecologist, the first test was more likely to be behind schedule, but the overall number of tests was higher and between-test intervals shorter. Because data was collected through private laboratories, our conclusions apply to the majority of French patients who need to schedule a separate visit for blood testing after prescription.

In Europe, congenital cytomegalovirus (CMV) infection is the leading cause of neurological disabilities in children, causing severe sequelae such as sensorineural hearing loss, neurodevelopmental delay or blindness. The infection causes high disease burden and costs. Nevertheless, there is little awareness of CMV among medical officials and the general public. Although the individual risk of congenital CMV infection is greatest from a primary infection of the mother during pregnancy, maternal non-primary infections also account for a substantial disease burden associated with congenital CMV. Screening programmes for pregnant women and newborns are widely discussed, but have not been implemented by any public health authority in Europe so far. This article gives an overview about a variety of European and other relevant studies regarding CMV seroprevalence, congenital CMV infection and disease as well as screening strategies and preventive approaches.

Problem drug use in pregnancy affects a sizeable population in Europe. A literature review was carried out of articles in PubMed, European Monitoring Centre for Drugs and Drug Addiction publications, and related documents in order to assess public health challenges and possible intervention strategies related to problem drug use and pregnancy in Europe. It revealed the following: Involving pregnant drug users in drug treatment is likely to decrease the chances of pre- and perinatal complications related to drug use and to increase access to prenatal care. Timely medical intervention can effectively prevent vertical transmission of human immunodeficiency virus, hepatitis B virus as well as certain other sexually transmitted diseases, and would allow newborns infected with hepatitis C virus during birth to receive immediate treatment. Pregnancy may be a unique opportunity to also help women with dual diagnosis (substance use combined with mental illness) and enrol them into special treatment and support programmes. Issues related to homelessness and intimate partner violence can also be addressed with appropriate interventions. Treatment and care for pregnant drug users should offer coordinated interventions in several areas: drug use, infectious diseases, mental health, personal and social welfare, and gynaecological/obstetric care.

The theme of this conference was 'public health action towards awareness, prevention, and treatment'. The purpose was to bring together researchers and clinicians from various fields to discuss the latest research on congenital cytomegalovirus (CMV) infection and how these findings can be translated into public health action for better health of women and children. In addition, families with children affected by congenital CMV participated in the conference, either in integrated sessions together with the experts or in separate sessions only for the families. These children were a testimony of the severe disabilities that congenital infections can cause. More than 250 participants from all over the world attended the conference, which included about 50 oral presentations and 50 poster presentations. In this report the different topics of this conference will be briefly discussed, with a focus on disease burden and public health. Most presentations can be found at: http://www.congenitalcmv.org/cmvslides2008.htm .