ECDC calls for systematic prenatal screening for HIV, hepatitis B and syphilis across Europe

The new European standards aim to ensure that infections that can be transmitted from parent to child are detected early enough for intervention and treatment. ECDC reports that in 2024, 196 HIV diagnoses attributed to vertical transmission and 140 confirmed cases of congenital syphilis were reported in the EU and EEA, while data for hepatitis B remain incomplete in many countries.

The European Centre for Disease Prevention and Control has published a common set of standards for prenatal screening for HIV, hepatitis B and syphilis, with the objective of reducing transmission of these infections from parent to child and making the quality of services comparable across EU and EEA countries. The document does not introduce new legal obligations for national healthcare systems, but establishes what ECDC considers quality care, what outcomes should be monitored and through which indicators the functioning of programmes can be assessed.

In brief

1.The standards cover prenatal screening for HIV, hepatitis B and syphilis and aim for detection sufficiently early to prevent vertical transmission.

2.ECDC reports 196 HIV diagnoses attributed to vertical transmission in the EU and EEA in 2024, of which 147 were recorded among migrants.

3.In the same year, 140 confirmed cases of congenital syphilis were reported, almost twice as many as in 2023.

4.For hepatitis B, European data on the route of transmission are much more incomplete, limiting precise assessment of vertical transmission.

5.The standards are built around quality requirements, measurable indicators and targets that can be audited by health systems.

The document starts from the fact that vertical transmission of the three infections can largely be prevented if diagnosis is made on time and the pregnant person quickly enters care. Prenatal screening thus becomes the first link in a chain that includes confirmation of the diagnosis, clinical assessment, treatment of the pregnant person, the interventions needed for the newborn and subsequent medical follow-up.

ECDC addresses HIV, hepatitis B and syphilis together because all three can be transmitted in connection with pregnancy or childbirth, but prevention differs from one infection to another. For HIV, antiretroviral treatment and appropriate management of pregnancy can drastically reduce the risk of transmission. For hepatitis B, identifying the infection allows prophylactic interventions for the newborn and, in certain situations, antiviral treatment during pregnancy. In syphilis, early diagnosis and antibiotic treatment can prevent transmission to the fetus and severe complications.

The data presented by ECDC show that the problem has not disappeared in Europe. In 2024, EU and EEA countries reported 196 new HIV diagnoses attributed to vertical transmission. Of these, 147, or 75%, were reported among migrants, defined by ECDC as people whose country of origin differs from the country reporting the diagnosis.

This figure must be interpreted with caution. It does not mean that all 147 transmissions occurred within European healthcare systems. Data on diagnosis and country of origin do not automatically establish where the infection occurred. ECDC nevertheless uses the distribution to show why screening programmes must also be accessible to people who enter the healthcare system late, including migrants and other vulnerable groups.

Congenital syphilis provides a different epidemiological signal. In 2024, 140 confirmed cases were reported in 28 EU and EEA countries, equivalent to a rate of 4.7 cases per 100,000 live births. The reported number almost doubled compared with the previous year, prompting ECDC once again to prioritise prevention of transmission during pregnancy.

For the 63 cases of congenital syphilis for which information on the mother’s country of birth was available, it differed from the reporting country in 17 instances. The proportion is much lower than that observed in the HIV data, showing that there is no single epidemiological profile common to all three infections.

In the case of hepatitis B, the main data problem is incompleteness. Information on the route of transmission was available for only 24% of acute cases reported in 2023 and 9% of chronic cases. Among acute cases with available information, approximately 1% were attributed to vertical transmission.

The picture is different for chronic hepatitis B. Among the 1,421 newly diagnosed cases for which the route of transmission was known, vertical transmission accounted for 39% and was the most frequently identified route. In 91% of these cases, however, the infection was classified as imported, meaning that transmission had occurred in the country of origin, not in the European country that reported the diagnosis.

This contrast explains why prenatal screening is treated both as a medical intervention and as an issue of access to services. A person may enter a European healthcare system after the infection has already been acquired elsewhere, but preventing transmission to the child depends on the possibility of being tested, diagnosed and treated in the country where the pregnancy takes place.

ECDC says that effective programmes must be universal and sufficiently accessible so as not to exclude people at higher risk from screening. The standards are built around a patient-centred approach, which the agency defines through equitable access, non-discrimination, clinical relevance and services adapted to the person’s needs.

This approach continues the direction established by previous European recommendations. ECDC has already supported testing for HIV, syphilis and hepatitis B during pregnancy, with repeat testing in certain risk situations and testing at delivery for people who were not tested previously. The new module shifts the focus from simply recommending screening to standardising the quality of the entire process.

Each standard follows the same structure. The document provides the clinical and public health rationale, formulates a requirement concerning service quality, identifies outcomes that can be measured and establishes numerical targets where possible. The idea is that a clinic or national system should be able to verify not only whether it formally offers screening, but also whether people are tested on time and subsequently reach the services they need.

This distinction is important. The existence of a national programme does not guarantee that it works for the entire population. There may be a universal screening policy while certain people do not attend prenatal care early enough, decline testing because of a lack of information, encounter administrative barriers or are not quickly connected to treatment after a positive result.

For hepatitis B, ECDC reported in the summer of 2026 that all EU and EEA countries for which information was available applied universal prenatal screening for HBsAg and that most of those reporting data had reached the World Health Organization’s interim target of 90% coverage. However, the absence of data from some countries prevents a complete assessment at European level.

The same analysis showed that information on treatment for eligible pregnant people with HBV infection was available for only four countries. In these countries, reported coverage was high, between 75% and 100%, but such a small sample does not allow the conclusion that the same performance exists across the EU and EEA.

Standardising indicators seeks to address precisely this type of problem. If countries measure different things or report data in incompatible formats, it is difficult to determine where prevention is working well and where gaps exist. A common definition of indicators can enable more useful comparisons between systems and can turn a lack of data into a visible problem.

The document also has a dimension related to eliminating vertical transmission as a public health problem. The international objective does not mean that no cases will ever occur again, but rather reducing transmission and achieving levels of coverage and performance compatible with criteria established by international organisations.

For Europe, the difficulty is that a relatively low overall incidence may conceal groups or regions where access is poorer. The total number of births in the EU and EEA was approximately 3.67 million in 2023, meaning that prenatal screening programmes must operate on a very large scale even if the final number of vertical transmission cases is small relative to the population.

This is also the logic behind quality indicators. A prevention programme is considered high-performing not only when the number of cases is low, but also when it can demonstrate that screening reaches the target population, results are communicated quickly, people with positive results receive the necessary intervention and children receive appropriate follow-up.

The standards do not replace national clinical protocols and do not require countries to organise services in the same way. They provide a common benchmark that authorities and providers can use for evaluation and audit. The actual organisation of screening and treatment remains the responsibility of national healthcare systems.

ECDC developed the module in partnership with the European AIDS Clinical Society and with clinical and public health experts from several European countries. The technical group includes specialists from Germany, Ukraine, Belgium, Bulgaria, Romania, Poland, Ireland, the Netherlands and Denmark, as well as community representation.

Its publication complements a broader series of European standards for prevention and care. Previous modules addressed HIV testing, pre-exposure prophylaxis, initiation of antiretroviral therapy and management of HIV together with other conditions. The prenatal module expands the framework to a point at which prevention can simultaneously affect the health of the parent and child.

The document’s significance is therefore not the introduction of a new test into European systems. Prenatal screening for these infections already exists in many countries. The innovation lies in the attempt to define at European level what a well-functioning programme means and how to measure the difference between the formal existence of screening and effective protection against vertical transmission.