CDC Issues New Guidelines for Screening Infants and Children for Hepatitis C
ATLANTA — The Centers for Disease Control and Prevention has released a series of recommendations for hepatitis C screening for infants and children who have been exposed to the virus in the womb.
The recommendations, which are spelled out in its Morbidity and Mortality Weekly Report, are that:
- All perinatally exposed infants should be screened for hepatitis C with a nucleic acid test for detection of hepatitis C RNA at ages 2-6 months.
- All infants and kids with detectable hepatitis C RNA should see a health care provider with expertise in pediatric hepatitis C management.
- A hepatitis C virus RNA screening be performed for perinatally exposed infants and children aged 7-17 months who previously have not been tested.
- A hepatitis C virus antibody test followed by a reflex nucleic acid test for HCV RNA be done for perinatally exposed kids aged 18 months and older who previously have not been tested.
The report goes on to say that exposed infants and kids with an undetectable hepatitis C RNA result 2 months old or older do not need to seek further follow-up unless such a follow-up is clinically warranted.
Hepatitis C virus is a single-stranded RNA virus that causes liver inflammation that can progress over time to advanced fibrosis, cirrhosis and hepatocellular carcinoma.
Rates of acute and chronic infections of the virus have been steadily increasing in the United States since 2010, with rates of acute infections more than tripling among reproductive-aged persons as of 2021.
As a result of increasing rates of acute infections in reproductive-aged persons and subsequent chronic infections, overall rates of hepatitis C virus infections during pregnancy have increased by 20% during 2016-2020 and up to tenfold during 2000-2019, the authors said.
HCV develops in 6%-7% of perinatally exposed infants and children, and these children often remain undiagnosed, the authors continued.
They go on to suggest the reasons for this could be a lack of awareness of perinatal exposure by pediatric providers, lack of regular pediatric care among exposed children and changes in health care providers before the time of hepatitis C virus testing.
The authors suggest that testing perinatally exposed infants beginning at age 2 months would not only be cost effective, but it would allow for earlier evaluation of the patient and earlier treatment.
The most common downsides to testing for perinatal HCV infection, the authors said, are intermittent or transient viremia, false-positive antibody results, false-negative antibody results, the cost of testing and stigma.
Nevertheless, they concluded their research by advising providers to adopt the recommendations for all infants and children born to pregnant persons with current or probable hepatitis C virus infection.
Dan can be reached at [email protected] and @DanMcCue
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