OVERVIEW

The hepatitis C virus (HCV) is a leading cause of death from liver disease and a major public health problem in adults in the United States. In the general US population, the prevalence of HCV infection is estimated to be 1.8%. In children, however, the seroprevalence ranges from 0.2% in children younger than 12 years to 0.4% in adolescents aged 12-19 years. This leads to an estimated 240,000 children with antibodies to HCV in the United States. Perinatal transmission from infected mothers is a recognized mode of transmission of HCV infection and is currently the most common route of infection in children. In this newsletter, we present the current screening recommendations for newborns born to mothers infected with HCV. We also review considerations specific for children infected with HCV.

PERINATAL TRANSMISSION OF HCV INFECTION

In the United States, the seroprevalence of HCV infection in pregnant women is approximately 1-2%. Perinatal transmission of HCV infection occurs only from mothers who are positive for HCV RNA at the time of delivery. The risk of perinatal transmission is about 5-6%. If the mother is co-infected with human immunodeficiency virus (HIV) and has especially high levels of HCV RNA, the rate of transmission may increase up to 19%.

RECOMMENDATIONS FOR INFANTS BORN TO MOTHERS INFECTED WITH HCV

According to the Centers for Disease Control and Prevention (CDC), children born to mothers infected with HCV are at intermediate risk of infection. The current screening practice as recommended by the CDC and the Report of the Committee on Infectious Diseases published by the American Academy of Pediatrics (AAP) is as follows:

• All children born to mothers infected with HCV should be tested for HCV infection.
• Testing is performed by detecting the presence of antibodies (anti-HCV). However, because of the presence of passive maternal antibodies in infants aged 18 months or younger, testing should be delayed until after that time.
• Reverse transcriptase-polymerase chain reaction (RT-PCR) assays for detection of HCV RNA may be performed at age 1-2 months, if earlier diagnosis is desired.
• All infected children should be vaccinated against hepatitis A virus (HAV) and hepatitis B virus (HBV) to prevent superinfection, which can lead to life-threatening clinical hepatitis.

IMPORTANT CONSIDERATIONS IN CHILDREN

Breastfeeding of infants born to mothers infected with HCV

Maternal HCV infection is not a contraindication to breastfeeding, according to the current guidelines of the US Public Health Service and the AAP. HCV transmission through breastfeeding has not been demonstrated in anti-HCV positive, anti-HIV negative mothers. Rates of transmission are similar between breastfed infants and bottle-fed infants. However, transmission through breastfeeding is, theoretically, possible. Antibodies to HCV and HCV RNA have been detected in breast milk from mothers infected with HCV. Mothers with cracked and bleeding nipples should consider abstaining from breastfeeding. A mother who is infected with HCV should decide whether or not to breastfeed her infant after an informed discussion with her health care professionals.

Child care of children infected with HCV

Exclusion of children infected with HCV from child care centers is not indicated, nor is restriction from school attendance or contact sports.

FUTURE DIRECTIONS

Improvements are needed in the diagnosis, treatment, and, most importantly, prevention of HCV in children. Stricter strategies are needed to screen and identify infected children. A prophylactic vaccine, as currently present for HAV and HBV, may be an effective control for HCV infection in children.

In addition, further research is needed to study the course of HCV infection in children, specifically the chronicity of the infection, presentation of symptoms, and the response to treatment. At this time, very little is known about the course of HCV infection in children who are infected perinatally. Current methods of treatment in adults also need to be better studied in children. This is especially true in children younger than 3 years, in whom current therapies are contraindicated at this time.

REFERENCES

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American Academy of Pediatrics. Transmission of infectious agents via human milk. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:118-21.

American Academy of Pediatrics. Hepatitis C. In: Pickering LK, ed. Red Book: 2003 Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics 2003:336-40.

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