Earlier this month, the Ministry of Health learned that Bermuda was revalidated for having achieved the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis.

Bermuda received its initial certification of EMTCT status in June 2017. 

EMTCT status is a prestigious public health accomplishment recognized globally.  Only 11 countries worldwide have achieved EMTCT status. 

"We were delighted and very proud of that achievement," said the Minister of Health the Hon. Kim Wilson JP MP.  "However, once achieved, EMTCT must be maintained. EMTCT validation indicates that Bermuda is proficient at preventing mother-to-child transmission of these infections.  Good antenatal care, early testing for HIV and syphilis and treatment for HIV positive mothers can prevent transmission of HIV from an HIV-positive mother to her infant during pregnancy, labor, delivery, or breastfeeding.

"However, HIV remains a threat and complacency is especially dangerous.  Both HIV and congenital syphilis have serious implications for the lives of babies and can be prevented.  Hence, the importance of maintaining elimination status."

Validation of elimination status is made by a special expert committee of the World Health Organization (WHO) which visits each country.  The Committee assesses a country’s systems for surveillance of HIV and syphilis in pregnancy, the laboratory capacity for accurate testing, access to antenatal care for all adolescents and women, private and public healthcare collaboration and care quality, among other indicators. Countries must demonstrate to Global Validation Advisory Committee (GVAC) standards that the country’s programs and procedures can be relied upon to identify early and treat cases of HIV or syphilis during pregnancy.  The standards do not require there to be no HIV or syphilis in the community, but rather countries must demonstrate that pregnant women are adequately tested and cared for in this regard.  Program indicators confirm that in Bermuda more than 95 per cent of pregnant women are tested early in pregnancy for HIV and syphilis.

Actual EMTCT “elimination” targets are: 

• the mother-to-child transmission (MTCT) rate of HIV is consistently less than 2%,
• the annual rate of new pediatric HIV infections per 1000 live births is less than 0.3, and
• the annual rate of congenital syphilis per 1000 live births is less than 0.5.

Minister Wilson added: "In September, Bermuda sent the required maintenance report to GVAC. Our report indicated both the processes used in Bermuda to assure all babies and mothers are tested for HIV and syphilis and provided necessary treatment to prevent mother-to-baby transmission.  In addition, we provided feedback on how Bermuda had responded to the recommendations made by the committee during the initial validation visit in June 2017. In order to prepare a maintenance report required an enormous amount of work on the part of the Ministry to collect data from Bermuda Hospitals Board (BHB), Register General and Epidemiology and Surveillance Unit (ESU).  We are particularly grateful for the generous collaborations with Department of Health and BHB professionals who played a critical role in this achievement by providing an enormous amount of clinical information."

The GVAC indicated to local health officials this month that Bermuda is "in a very strong position to continue to maintain validation of EMTCT of HIV and syphilis.”  They highlighted “Bermuda’s strong expertise and commitment to EMTCT of HIV and syphilis” and commended us for “these national, regional and global achievements.”

The next review for maintenance of validation of EMTCT will be September 2021.