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When and How to Screen Infants for Hepatitis C

When and How to Screen Infants for Hepatitis C

What are the appropriate laboratory tests for an infant whose mother has hepatitis C virus (HCV) infection? -- Robert Blereau, MD
   Morgantown, La
The prevalence of antibodies to HCV in pregnant women is around 1% (range, 0.1% to 2.4%).1 Of pregnant women in whom HCV antibodies are detected, 60% to 70% are actively viremic. Vertical transmission of HCV appears to occur only when serum HCV RNA is detectable and may be more common with higher levels of viremia (above 106 copies/mL).1-3 When a pregnant woman has detectable HCV RNA at the time of delivery, the risk of transmission is 4% to 7%. Maternal coinfection with HIV increases this risk to as high as 20%.4 Although there are no data to support the use of elective cesarean section for the prevention of vertical transmission of HCV, it is prudent to avoid fetal scalp monitoring and prolonged rupture of membranes; either may increase the risk of transmission. The use of interferon or ribavirin is contraindicated during pregnancy. Breast-feeding does not appear to transmit HCV but should be avoided if the nipples are cracked or bleeding.5 HCV antibodies are transferred through the placenta, and they may be detected in the infant for as long as 15 months--and occasionally 18 months-- after birth.1,6 If transmission of the virus occurs, HCV RNA can be detected a few days after delivery and may persist or be cleared spontaneously. The frequency and rate of spontaneous clearance are unknown, but infants appear to clear the infection more often than adults. Screen an infant born to an HCV-infected mother for HCV RNA once between the ages of 2 and 6 months and again between 18 and 24 months; at the second screening, also test for anti-HCV.1,6 Suspect chronic infection if these latter tests are positive.
-- Andr N. Sofair, MD, MPH
   Assistant Professor of Medicine
   Yale University School of Medicine
   New Haven, Conn

References

REFERENCES:
1. Roberts EA, Yeung L. Maternal-infant transmission of hepatitis C virus infection. Hepatology. 2002;36: S106-S113.
2. Dienstag J. Sexual and perinatal transmission of hepatitis C. Hepatology. 1997;26:S66-S70.
3. Ohto H, Terasawa S, Sasaki N, et al. Transmission of hepatitis C virus from mothers to infants. N Engl J Med. 1994;330:744-750.
4. National Institutes of Health Consensus Development Conference Statement: management of hepatitis C 2002. Gastroenterology. 2002;123:2082-2099.
5. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 1998;47(RR-19):1-39.
6. Pawlotsky JM. Use and interpretation of virologic tests for hepatitis C. Hepatology. 2002;36:S65-S73.
 
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