No 38 - 2022

Screening of pregnant women for hepatitis B, HIV and syphilis, 2020 and 2021

• In 2020, the pregnancy screening detected 142 pregnant women with hepatitis B, 23 with HIV and 14 with confirmed syphilis. In 2021, 117 pregnant women had hepatitis B detected, 18 had HIV detected and 15 were confirmed to have syphilis.

• In 2020 and 2021, 39 of the 41 pregnant women with HIV had previously been diagnosed with HIV and were in treatment. Among the 29 pregnant women with syphilis, 25 were diagnosed in connection with the pregnancy screening.

• More than half of the pregnant women with syphilis were born in Denmark.

• All pregnant women with hepatitis B, syphilis or HIV are to be referred to a specialised department.

• Midwives and other healthcare workers who vaccinate neonates whose mothers are hepatitis B carriers must register this in the FMK (Joint Medicine Card)/DDV (The Danish Vaccination Register).

• The GP must ensure that a serological test of the vaccination effect is performed in children of hepatitis B carrier mothers.

• Well-treated HIV-positive women do not transmit the HIV infection to their children during their pregnancy or during labour.

• The GP can choose to test for HIV and syphilis several times during pregnancy.

• HIV testing of partners from high-endemic countries may be offered - even if the pregnant woman tests negative.

Screening of pregnant women for hepatitis B virus (HBV) was introduced on 1 November 2005, and screening for HIV and syphilis was initiated on 1 January 2010. The 2020 and 2021 annual report is now available.

In 2020 and 2021, a total of 69,208 and 67,476 blood type analyses were performed in pregnant women. Practically all of these women (99.9%) were tested for hepatitis B virus, HIV and syphilis.

Thus, the overwhelming majority of pregnant women accept the offer of hepatitis B, HIV and syphilis screening; and therefore nearly all potential cases of mother-to-child transmission with the three conditions can be avoided.

The majority of pregnant women with hepatitis B or HIV were born abroad. In 2020, nine of 14 pregnant women with syphilis were born in Denmark. In 2021, eight of 15 pregnant women with syphilis were born in Denmark. This shows that, in Denmark, syphilis is not exclusively a condition that occurs among men who have sex with men or immigrants from high-incidence countries; it has been re-introduced among heterosexual Danes.

In 2020 and 2021, six and four women, respectively, never had an extended confirmatory syphilis test performed although they were encouraged to have such a test by the SSI.

The general practitioner's tasks in relation to pregnancy screening

The general practitioner's tasks in relation to pregnancy screening are presented in Table 1.



Pregnant women who stay in the country as undocumented immigrants may be examined by a physician at a Red Cross health clinic in Copenhagen or Aarhus. Here, pregnancy screening is also offered, but this service does not form part of the public offer of care for childbearing women. The maternity ward shall obtain blood samples to test for syphilis, hepatitis B and do a rapid HIV test of any woman in labour with an unknown status admitted to the ward.

In case of a positive screening result, the pregnant woman needs to be informed that the majority of screening findings are false positives, but that an extended analysis is needed to confirm or disprove the result. Furthermore, the pregnant woman needs to be informed that - if she does indeed have syphilis - the condition is treatable so that she will not transmit the condition to her child. Additionally, the pregnant woman needs to be informed of the importance of having her sexual partner(s) tested and, if needed, treated.

It is important that treating physicians refer any pregnant woman who has had one of the three infections detected in the screening to the relevant specialist departments, even if the woman in question has no infection symptoms, Table 1. Pregnant women with a high HBV virus amount (>106 IU/ml) may typically be offered treatment at approx. 28 weeks of gestation, which may reduce the risk of intrauterine transmission, cf. guidelines on the treatment of hepatitis, prepared by the Danish Society for Gastroenterology and Hepatology (in Danish language).

In pursuance of the Danish Health Authority's guideline on general screening of pregnant women for infection with hepatitis B, HIV and syphilis, the pregnant woman's partner and other children should have blood tests taken.

According to the Danish Health Authority’s guideline on HIV, hepatitis B and C virus published in 2013, all children born by HBV carrier mothers who receive hepatitis B vaccination at birth and subsequently at the GP should be tested to confirm that the vaccination has taken and to test for current infection one month after the vaccination series has been concluded, Table 1, i.e., when the child is 13-15 months old. This is necessary because inter-uterine infection occurs in some children, in which case the vaccine is ineffective. The responsibility for performing this test lies with the GP, Table 1. If the child has become infected, he or she should be referred to a paediatric department. If the child is insufficiently covered (anti-HBs <10 IU/L) despite the vaccinations, an additional vaccination may be given after which antibodies are measured one month later. If the child is still insufficiently covered, he or she is referred to a paediatric department. Statens Serum Institut sends out reminders to the GPs about hepatitis B vaccination of children born by hepatitis B-carrier mothers and about subsequent testing of these children.

Recording of hepatitis B vaccination in the JMC/DVR

Physicians, nurses and midwives who give the vaccine have a legal obligation to register this in the FMK/DDV.

Previously, it was a problem that neonates would appear in the FMK/DDV only some days after labour. This has now been changed so that the children can be found by searching for their civil registration number (CPR number) shortly after birth.

Hepatitis B vaccination and the vaccination course termed “Hepatitis B post-exposure for neonates” (In Danish: ”Hepatitis B post-eksposition til nyfødte”) are added under Add new vaccination (In Danish: “Opret ny vaccination”) in the FMK/DDV. Immunoglobulin cannot be registered in the FMK/DDV as it is not a vaccine.

When a vaccination course is established, the parents and the GP will automatically gain access to the dates at which the next vaccinations are to be given.

(A.K. Hvass, L.H. Hvass, S. Cowan, Department of Infectious Disease Epidemiology and Prevention)
21 September 2022