Women in Scotland are currently offered screening to allow the early identification of Hepatitis B, Syphilis and HIV. This allows management interventions to be offered to prevent mother to child transmission of Hepatitis B, HIV and syphilis as well as safeguarding the wellbeing of the mother. It is strongly recommended that screening be offered regardless of what gestation the women first presents, including in labour and postnatally, as there are still management options that can improve the wellbeing of the woman and baby if a positive diagnosis is made even late in pregnancy or in the postnatal period.
Screening for rubella susceptibility in Scotland ceased on the 1st June 2016 following approval from Ministers
The UK National Screening Committee (UK NSC) reviewed the evidence for rubella susceptibility screening in 2003 and 2012 and on both occasions advised that screening for rubella susceptibility did not meet the UK NSC criteria for a national screening programme and should be discontinued for the following reasons:
- The extremely low incidence of congenital rubella syndrome does not indicate the need for a population screening programme and is at a level defined as eliminated by the World Health Organisation.
- The test may falsely reassure some women that they are not susceptible to rubella infection during that pregnancy
- The focus on antenatal screening and postnatal immunisation may not be the optimum intervention to address rubella susceptibility as a public health issue in the wider population
- Alternative approaches to high levels of immunity in the total population may be more effective to ensure that women are protected against rubella infection prior to pregnancy
The UK NSC and the JCVI further reported that stopping antenatal screening is extremely unlikely to increase congenital rubella syndrome rates and that the population level of uptake of the first dose of MMR is now sufficient to stop screening.
Evidence
The evidence based reasons to end screening for rubella susceptibility include:
- Stopping antenatal screening is unlikely to increase rates of rubella. There are very few cases of rubella in the UK – with 12 cases of congenital rubella occurring in the decade 2005-2015. None of which could have been prevented by the screening programme
- Screening for rubella susceptibility in pregnancy does not give any protection to the unborn baby
- Being fully immunised with the MMR vaccine before becoming pregnant is the most effective way of ensuring women are protected against rubella in pregnancy
Policy Decision
Ministers have agreed that rubella susceptibility screening in pregnancy should cease in Scotland from 1 June 2016. The decision to end screening for rubella susceptibility in pregnancy has been made possible by the high levels of vaccination rates achieved through the MMR vaccination programme. Figures in Scotland show that 95% of children aged up to two years had received at least one MMR vaccination; with 97% having received at least one dose of MMR by five years.
The key points for maternity services to note are
- the offer of antenatal screening should stop for all women in Scotland booking on or after 1 June 2016
- screening for HIV, hepatitis B and syphilis should continue to be offered to all eligible women
- the rubella screening pathway should be completed for women booking and accepting screening before 1 June, meaning:
- laboratories will test decreasing numbers of samples in July, August and September 2016 and will need to adjust assay supplies accordingly
- continued reporting and follow-up of results for women booking into this cohort by screening teams
- continued administration of postnatal MMR by maternity services and referral to primary care for second vaccination for non-immune women in this booking cohort
The protocols document contains standard national protocols for all healthcare professionals involved in the NHS Scotland Communicable Diseases screening programme. In order to ensure equity of service across Scotland, NHS Boards are required to ensure that the screening service provided locally adheres to these protocols.
For women booking on or after the 1st June 2016 the following protocols and patient pathway should be followed:
Screening for communicable diseases in pregnancy – 2016 Protocols version 1
A training resource highlighting the key points can be found below
2016-06-01 Cessation of screening for rubella
For women who booked prior to June 1st 2016 the previous 2014 protocols (below) should be followed, this includes the offer of postnatal immunisation.
Screening for communicable diseases in pregnancy – 2014 Protocols version 1
The link below is to the flyer announcing the updated patient information resources that are available and should be used for women booking after 1st June 2016
Important changes to the screening programme_xxxx
The following is a link to guidance on the management of rash in pregnancy. Please note this is an external publication and has yet to be updated to note that screening during pregnancy is no longer recommended but the guidance on rash in pregnancy is still relevent.
Viral_rash_in_pregnancy_guidance V3_Your Guide