Evaluating progress towards triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Netherlands, 2012-2015

Background In 2014 the World Health Organisation (WHO) established validation criteria for elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Additionally, the WHO set targets to eliminate hepatitis, including hepatitis B (HBV). We evaluated to what extent the Netherlands has achieved the combined WHO criteria for EMTCT of HIV, syphilis and HBV. Methods Data of HIV, syphilis and HBV infections among pregnant women and children (born in the Netherlands with congenital infection) for 2012-2015, and data required to validate the WHO criteria were collected from multiple sources: the antenatal screening registry, the HIV monitoring foundation database, neonatal registration of congenital syphilis diagnoses, and national HBV notification data. Results Prevalence of HIV, syphilis and HBV was stably low among pregnant women and children (Table 1). With a screening coverage of >99% since 2012, the WHO criterion of antenatal screening for HIV and syphilis (>90%) was amply met in the Netherlands. All WHO criteria specific for HIV were also met: antiretroviral treatment of pregnant women of ≥90% (Netherlands: 96% in 2014 and 100% in 2015), case rate of HIV of ≤50 per 100,000 live births (0.57 in 2014 and 0.00 in 2015), and MTCT rate of ≤2% (0.75% for 2014 and 2015 combined). For HBV all targets were accomplished as well: vaccination coverage for children was ≥90% (universal vaccination coverage 93.1% for birth-cohort 2014, birth-dose vaccination and immunoglobulin admission at birth to children of HBV-positive mothers >99% in 2014 and 2015), and prevalence among children was ≤0.1% (0.0% in both 2014 and 2015). For syphilis, data were lacking to validate the goal of ≥95% treatment of syphilis-seropositive pregnant women. Data on congenital syphilis were partly lacking and only included live born children, but the WHO goal of ≤50 cases/100,000 live births is not expected to be exceeded. Conclusions In the Netherlands, the antenatal screening programme has a very high coverage and the prevalence of maternal HIV, syphilis and HBV is low. Congenital infections are extremely rare. The WHO criteria for validation of EMTCT are met for HIV and HBV, but for syphilis more data are needed to prove elimination. Table 1: Estimated prevalence for HIV, syphilis and hepatitis B among pregnant women and case rate among children in the Netherlands, 2012-2015, see poster.