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'''HCV infections in children and pregnancy''' are less understood than in adults. Worldwide, the prevalence of ] infection in pregnant women and children has been estimated to 1-8% and 0.05-5% respectively.<ref name=Arshad2011>{{cite journal|vauthors=Arshad M, El-Kamary SS, Jhaveri R |year=2011 |title=Hepatitis C virus infection during pregnancy and the newborn period--are they opportunities for treatment? |journal=Journal of Viral Hepatitis |volume=18|issue=4|pages=229–236 |doi=10.1111/j.1365-2893.2010.01413.x |pmid=21392169|s2cid=35515919 }}</ref> The vertical ] has been estimated to be 3-5% and there is a high rate of spontaneous clearance (25-50%) in the children. Higher rates have been reported for both vertical transmission (18%, 6-36% and 41%).<ref name=Hunt1997>{{cite journal|vauthors=Hunt CM, Carson KL, Sharara AI |year=1997|title=Hepatitis C in pregnancy |journal=Obstet Gynecol |volume=89 |issue=5 Pt 2 |pages=883–890 |doi=10.1016/S0029-7844(97)81434-2|pmid=9166361|s2cid=23182340}}</ref><ref name=Thomas1998>{{cite journal |vauthors=Thomas SL, Newell ML, Peckham CS, Ades AE, Hall AJ |year=1998 |title=A review of hepatitis C virus (HCV) vertical transmission: risks of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection |journal=Int J Epidemiol |volume=27 |issue=1 |pages=108–117 |doi=10.1093/ije/27.1.108 |pmid=9563703|doi-access=free }}</ref> and prevalence in children (15%).<ref name=Fischler2007>{{cite journal |author=Fischler B |year=2007 |title=Hepatitis C virus infection |journal=Semin Fetal Neonatal Med |volume=12 |issue=3 |pages=168–173 |doi=10.1016/j.siny.2007.01.008 |pmid=17320495}}</ref> |
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Infections of the ] (HCV) in ]ren and ] are less understood than those in other adults. Worldwide, the prevalence of HCV infection in pregnant women and children has been estimated to 1-8% and 0.05-5% respectively.<ref name=Arshad2011>{{cite journal|vauthors=Arshad M, El-Kamary SS, Jhaveri R |year=2011 |title=Hepatitis C virus infection during pregnancy and the newborn period--are they opportunities for treatment? |journal=Journal of Viral Hepatitis |volume=18|issue=4|pages=229–236 |doi=10.1111/j.1365-2893.2010.01413.x |pmid=21392169|s2cid=35515919 }}</ref> The vertical transmission rate has been estimated to be 3-5% and there is a high rate of spontaneous clearance (25-50%) in the children. Higher rates have been reported for both vertical transmission (18%, 6-36% and 41%).<ref name=Hunt1997>{{cite journal|vauthors=Hunt CM, Carson KL, Sharara AI |year=1997|title=Hepatitis C in pregnancy |journal=Obstet Gynecol |volume=89 |issue=5 Pt 2 |pages=883–890 |doi=10.1016/S0029-7844(97)81434-2|pmid=9166361|s2cid=23182340}}</ref><ref name=Thomas1998>{{cite journal |vauthors=Thomas SL, Newell ML, Peckham CS, Ades AE, Hall AJ |year=1998 |title=A review of hepatitis C virus (HCV) vertical transmission: risks of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection |journal=Int J Epidemiol |volume=27 |issue=1 |pages=108–117 |doi=10.1093/ije/27.1.108 |pmid=9563703|doi-access=free }}</ref> and prevalence in children (15%).<ref name=Fischler2007>{{cite journal |author=Fischler B |year=2007 |title=Hepatitis C virus infection |journal=Semin Fetal Neonatal Med |volume=12 |issue=3 |pages=168–173 |doi=10.1016/j.siny.2007.01.008 |pmid=17320495}}</ref> |
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In ], transmission around the time of birth is now the leading cause of HCV infection. In the absence of virus in the mother's blood, transmission seems to be rare.<ref name="Thomas1998"/> Factors associated with an increased rate of infection include ] of longer than 6 hours before delivery and procedures exposing the infant to maternal blood.<ref name=Indolfi2009>{{cite journal |vauthors=Indolfi G, Resti M |year=2009 |title=Perinatal transmission of hepatitis C virus infection |journal=J Med Virol |volume=81 |issue=5 |pages=836–843 |doi=10.1002/jmv.21437 |pmid=19319981|s2cid=21207996 }}</ref> ]s are not recommended. ] is considered safe if the nipples are not damaged. Infection around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission. |
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In ], transmission around the time of birth is now the leading cause of HCV infection. In the absence of virus in the mother's blood, transmission seems to be rare.<ref name="Thomas1998"/> Factors associated with an increased rate of infection include ] of longer than 6 hours before delivery and procedures exposing the infant to maternal blood.<ref name=Indolfi2009>{{cite journal |vauthors=Indolfi G, Resti M |year=2009 |title=Perinatal transmission of hepatitis C virus infection |journal=J Med Virol |volume=81 |issue=5 |pages=836–843 |doi=10.1002/jmv.21437 |pmid=19319981|s2cid=21207996 }}</ref> ]s are not recommended. ] is considered safe if the nipples are not damaged. Infection around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission. |
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Guidelines for the investigation of babies born to ] positive mothers have been published.<ref name=Resti2003>{{cite journal |author=Resti M, Bortolotti F, Vajro P, Maggiore G, Committee of Hepatology of the Italian Society of Pediatric Gastroenterology and Hepatology |year=2003 |title=Guidelines for the screening and follow-up of infants born to anti-HCV positive mothers |journal=Dig Liver Dis |volume=35 |issue=7 |pages=453–457 |doi=10.1016/s1590-8658(03)00217-2|pmid=12870728 }}</ref> |
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Guidelines for the investigation of babies born to ] positive mothers have been published.<ref name=Resti2003>{{cite journal |author=Resti M, Bortolotti F, Vajro P, Maggiore G, Committee of Hepatology of the Italian Society of Pediatric Gastroenterology and Hepatology |year=2003 |title=Guidelines for the screening and follow-up of infants born to anti-HCV positive mothers |journal=Dig Liver Dis |volume=35 |issue=7 |pages=453–457 |doi=10.1016/s1590-8658(03)00217-2|pmid=12870728 }}</ref> |
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:In children born to hepatitis C virus ] positive but hepatitis C virus RNA negative mothers, the ] and hepatitis C virus antibodies should be investigated at 18-24 months of life. If both the alanine aminotransferase value is normal and hepatitis C virus antibody is not found, follow up should be interrupted. |
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:In children born to hepatitis C virus ] positive but hepatitis C virus RNA negative mothers, the ] and hepatitis C virus antibodies should be investigated at 18-24 months of life. If both the alanine aminotransferase value is normal and hepatitis C virus antibody is not found, follow up should be interrupted.{{cn|date=November 2022}} |
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:In children born to hepatitis C virus RNA positive mothers, alanine aminotransferase and hepatitis C virus RNA should be investigated at 3 months of age. Of these |
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:In children born to hepatitis C virus RNA positive mothers, alanine aminotransferase and hepatitis C virus RNA should be investigated at 3 months of age. Of these{{cn|date=November 2022}} |
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::(1) hepatitis C virus RNA positive children should be considered infected if ] is confirmed by a second assay performed by the 12th month of age |
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::(1) hepatitis C virus RNA positive children should be considered infected if ] is confirmed by a second assay performed by the 12th month of age |
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::(3) hepatitis C virus RNA negative children with normal alanine aminotransferase should be tested for antibodies to the hepatitis C virus and have their alanine aminotransferase reestimated at 18-24 months. They should be considered non infected if both the alanine aminotransferase is normal and the antibody levels to the hepatitis C virus are undetectable. |
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::(3) hepatitis C virus RNA negative children with normal alanine aminotransferase should be tested for antibodies to the hepatitis C virus and have their alanine aminotransferase reestimated at 18-24 months. They should be considered non infected if both the alanine aminotransferase is normal and the antibody levels to the hepatitis C virus are undetectable. |
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:The presence of anti hepatitis C virus antibody beyond the 18th month of age in a never viremic child with normal alanine aminotransferase is likely consistent with past hepatitis C virus infection. |
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:The presence of anti hepatitis C virus antibody beyond the 18th month of age in a never viremic child with normal alanine aminotransferase is likely consistent with past hepatitis C virus infection.{{cn|date=November 2022}} |
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==Treatment== |
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==Treatment== |
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Treatment of children has been with ] and ].<ref name=Hu2010>{{cite journal |vauthors=Hu J, Doucette K, Hartling L, Tjosvold L, Robinson J |title=Treatment of hepatitis C in children: a systematic review |journal=PLOS ONE |date=Jul 13, 2010 |volume=5 |issue=7 |pages=e11542 |doi=10.1371/journal.pone.0011542 |pmid=20644626 |pmc=2903479 |bibcode=2010PLoSO...511542H |doi-access=free }}</ref> The response to treatment is similar to that in adults.<ref name=Serranti2011>{{cite journal |vauthors=Serranti D, Buonsenso D, Ceccarelli M, Gargiullo L, Ranno O, Valentini P |year=2011 |title=Pediatric hepatitis C infection: to treat or not to treat...what's the best for the child? |journal=Eur Rev Med Pharmacol Sci |volume=15 |issue=9 |pages=1057–1067|pmid=22013729 }}</ref> It shows a similar dependence on the genotype. Recurrence after ] is universal and the outcomes after transplant are usually poor.<ref name=Rumbo2006>{{cite journal |vauthors=Rumbo C, Fawaz RL, Emre SH, Suchy FJ, Kerkar N, Morotti RA, Shneider BL |year=2006 |title=Hepatitis C in children: a quaternary referral center perspective |journal=J Pediatr Gastroenterol Nutr |volume=43 |issue=2 |pages=209–216 |doi=10.1097/01.mpg.0000228117.52229.32|pmid=16877987 |s2cid=38432144 }}</ref> |
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Treatment of children has been with ] and ].<ref name=Hu2010>{{cite journal |vauthors=Hu J, Doucette K, Hartling L, Tjosvold L, Robinson J |title=Treatment of hepatitis C in children: a systematic review |journal=PLOS ONE |date=Jul 13, 2010 |volume=5 |issue=7 |pages=e11542 |doi=10.1371/journal.pone.0011542 |pmid=20644626 |pmc=2903479 |bibcode=2010PLoSO...511542H |doi-access=free }}</ref> The response to treatment is similar to that in adults.<ref name=Serranti2011>{{cite journal |vauthors=Serranti D, Buonsenso D, Ceccarelli M, Gargiullo L, Ranno O, Valentini P |year=2011 |title=Pediatric hepatitis C infection: to treat or not to treat...what's the best for the child? |journal=Eur Rev Med Pharmacol Sci |volume=15 |issue=9 |pages=1057–1067|pmid=22013729 }}</ref> It shows a similar dependence on the genotype. Recurrence after ] is universal and the outcomes after transplant are usually poor.<ref name=Rumbo2006>{{cite journal |vauthors=Rumbo C, Fawaz RL, Emre SH, Suchy FJ, Kerkar N, Morotti RA, Shneider BL |year=2006 |title=Hepatitis C in children: a quaternary referral center perspective |journal=J Pediatr Gastroenterol Nutr |volume=43 |issue=2 |pages=209–216 |doi=10.1097/01.mpg.0000228117.52229.32|pmid=16877987 |s2cid=38432144 |doi-access=free }}</ref> |
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In children treatment should be initiated within 12 weeks of the detection of the viral RNA if viral clearance has not occurred within this time.<ref name=Lagging2012>{{cite journal |vauthors=Lagging M, Duberg AS, Wejstål R, Weiland O, Lindh M, Aleman S, Josephson F, ((Swedish Consensus Group)) |year=2012 |title=Treatment of hepatitis C virus infection in adults and children: updated Swedish consensus recommendations |journal=Scand J Infect Dis |volume=44 |issue=7 |pages=502–521 |doi=10.3109/00365548.2012.669045 |pmid=26624849 |pmc=4732459 }}</ref> Given the difficulties with establishing a diagnosis of hepatitis C infection in infancy, this recommendation does not apply to infants.{{cn}} |
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In children treatment should be initiated within 12 weeks of the detection of the viral RNA if viral clearance has not occurred within this time.<ref name=Lagging2012>{{cite journal |vauthors=Lagging M, Duberg AS, Wejstål R, Weiland O, Lindh M, Aleman S, Josephson F, ((Swedish Consensus Group)) |year=2012 |title=Treatment of hepatitis C virus infection in adults and children: updated Swedish consensus recommendations |journal=Scand J Infect Dis |volume=44 |issue=7 |pages=502–521 |doi=10.3109/00365548.2012.669045 |pmid=26624849 |pmc=4732459 }}</ref> Given the difficulties with establishing a diagnosis of hepatitis C infection in infancy, this recommendation does not apply to infants.{{cn|date=August 2022}} |
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Both ] and ] are unsuitable for use in pregnancy and infancy: newer methods of treatment are urgently required.{{cn}} |
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Both ] and ] are unsuitable for use in pregnancy and infancy: newer methods of treatment are urgently required.{{cn|date=August 2022}} |
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==References== |
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==References== |
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{{Viral diseases}} |
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{{gastroenterology}} |
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{{Pregnancy}} |
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In children treatment should be initiated within 12 weeks of the detection of the viral RNA if viral clearance has not occurred within this time. Given the difficulties with establishing a diagnosis of hepatitis C infection in infancy, this recommendation does not apply to infants.