Antenatal screening for hepatitis B infection and syphilis in the UK

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 di rectorates. 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 hep atitis 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 testin g policy. The prevalence of chronic hepatitis B virus ranged from 0.3 to 17 .5 per 1000 deliveries. Universal antenatal screening for serological evide nce of syphilis was the norm, but five obstetric centres respondents and th ree Public Health directors were considering its discontinuation. In the ni ne London centres, syphilis prevalence was 2.06 per 1000 pregnant women, co mpared with 0.24 per 1000 elsewhere. Responses from Public Health directors indicated the nonspecific nature of the antenatal care contract. Responsib ility for hepatitis B virus vaccination of the newly born infant rests with the hospital paediatrician, with transfer of responsibility to the communi ty usually occurring through a discharge letter Only two areas had a monito ring system to ensure full hepatitis B virus vaccination coverage of expose d 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 mon itor local policy and practice.