By Ethan Covey As part of ongoing efforts to achieve goals of hepatitis C virus (HCV) elimination in the United States, the CDC released recommendations for testing children and infants who have been exposed to the virus perinatally—either during pregnancy or delivery.
The action comes amidst increasing rates of HCV infection in the United States (MMWR Recomm Rep 2023;72[4]:1-19
The elimination of hepatitis C is a national priority,” Carolyn Wester, MD, the director of the CDC’s Division of Viral Hepatitis, told Infectious Disease Special Edition. “Without treatment, hepatitis C can be deadly. Fortunately, hepatitis C can be cured; testing is the first step.
“In 2020, the CDC released universal screening recommendations for adults, which included a recommendation to test pregnant people during each pregnancy,” Dr. Wester continued (MMWR Recomm Rep 2020;69[2]:1-17).
Rates of acute HCV infections have been increasing steadily, more than tripling from 2010 to 2021, and are highest among people between 20 and 39 years of age. One result of this increase among people of reproductive age is rates of HCV infection during pregnancy have also increased steeply. HCV can be transmitted from mother to child, and an estimated 6% to 7% of all infants exposed to hepatitis C during pregnancy or delivery will acquire HCV infection.
To address this, the newly published CDC report details four new HCV recommendations:
- HCV testing of all perinatally exposed infants with a nucleic acid test (NAT) for detection of HCV RNA at 2 to 6 months of age;
- consultation with a healthcare provider with expertise in pediatric hepatitis C management for all infants and children with detectable HCV RNA; and
- perinatally exposed infants and children with an undetectable HCV RNA result at or after 2 months do not require further follow-up unless clinically warranted.
- A NAT for HCV RNA is recommended for perinatally exposed infants and children at 7 to 17 months who had not been tested, and an HCV antibody (anti-HCV) test followed by a reflex NAT for HCV RNA (when anti-HCV is reactive) is recommended for perinatally exposed children who are at least 18 months of age who had not been tested.
“The identification of hepatitis C infection and linkage to lifesaving treatment is essential to protecting the health of adults and children with hepatitis C and achieving national elimination goals,” Dr. Wester added.
“Healthcare providers are encouraged to implement CDC’s newest recommendations for hepatitis C, including testing all adults once, all pregnant persons during each pregnancy, and all infants and children born to pregnant people with hepatitis C.”
There is hope that these new testing recommendations, in concert with the existing screening guidelines, will allow for cost-effective ways to identify HCV infections, and promptly link patients to both care and treatment.
“Testing is the essential first step to accessing lifesaving hepatitis C treatment,” Dr. Wester said.
