CDC supports hepatitis C screening for children exposed in utero

CDC has issued new recommendations for hepatitis C virus (HCV) screening of perinatally exposed infants and children.

Four new recommendations in detail MMWR Recommendations and Reports As stated below:

• All perinatally exposed infants should be screened for HCV at 2 to 6 months of age with nucleic acid testing (NAT) to detect HCV RNA
• All infants and children with detectable HCV RNA should see a health care provider with expertise in pediatric hepatitis C management
• Exposed infants and children with undetectable HCV RNA results at 2 months of age or later do not need to seek further follow-up unless “clinically necessary”
• HCV RNA NAT is recommended for perinatally exposed infants and children 7 to 17 months who have not previously been tested, and HCV antibody testing is recommended for perinatal testing followed by HCV RNA reflex NAT (when anti-HCV reactive) Exposed children 18 months and older who have not been previously tested

Lakshmi Panagiotakopoulos, M.D., of the National Cancer Institute, noted that while HCV infection rates have been rising in people of childbearing age and in pregnant women, a systematic review of data from 12 studies showed that only 30.1% of perinatally exposed infants and children became infected with HCV. detection. Center for HIV, Viral Hepatitis, STD and Tuberculosis Prevention and colleagues.

Six to 7 percent of perinatally exposed infants and children become infected with HCV, and these children often go undiagnosed, they wrote, adding that reasons may include “a lack of knowledge among pediatric providers about perinatal exposures” awareness and lack of regular pediatric care among exposed populations.” Children, and changes in health care providers before HCV testing (currently recommended at 18 months of age). “

They continued that testing perinatally exposed infants starting at 2 months of age “is cost-effective and allows for earlier linkage to care, appropriate assessment, and the opportunity to provide curative, life-saving treatment.” ”, noting that children typically attend well-child exams in the first 6 months of life rather than 18 months or later.

In addition, the FDA has approved direct-acting antiviral treatments for children older than 3 years of age. As a result, Panagiotakopoulos and team emphasized, “the benefits of testing were determined to outweigh any potential and identified harms.”

“The most common harms associated with testing for perinatal HCV infection are related to the interpretation of test results, including intermittent or transient viremia, false-positive antibody results, false-negative antibody results, cost of testing, and stigma,” they wrote. “However, NAT currently used for HCV RNA detection is highly sensitive and specific for diagnosing perinatal HCV transmission.”

Ultimately, CDC researchers recommend that health care providers implement these updated recommendations for all infants and children born to pregnant women who are currently or potentially infected with hepatitis C virus.

As of April 2020, the CDC’s previous recommendation was that all patients 18 years and older be screened for HCV at least once in their lifetime, and that those with confirmed exposure to the virus (such as injection drug use) should be screened for HCV regardless of age. Screening. The only exception is people living in areas with an HCV RNA positivity rate <0.1.

“Whenever a child is seen by a health care provider, opportunities exist for education, testing and evaluation, curative treatment, and progress toward the goal of eliminating hepatitis C,” the authors concluded.