Hepatitis C virus infection in children
- Maureen M Jonas, MD
Maureen M Jonas, MD
- Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
Children represent only a small proportion of the hepatitis C virus (HCV) infected population. Nevertheless, a substantial number of children have chronic HCV infection and are at risk for complications. According to one report , there are approximately 115 million infected persons in the world, 11 million of whom are younger than 15 years of age. Eighty million are viremic, of whom 5 million are younger than 15 years of age. It has been estimated that the global health care costs for HCV-infected children and their families are hundreds of millions of dollars annually .
The major issues related to HCV in children will be reviewed here. Perinatal transmission of HCV is discussed separately. (See "Vertical transmission of hepatitis C virus".)
In the United States, antibodies to HCV are present in approximately 0.2 percent of children ages 6 to 12 and in 0.4 percent of those ages 12 to 19, rates that are similar to the prevalence observed in volunteer adult blood donors but that are lower than adult prevalence based upon National Health and Nutrition Examination (NHANES) survey data [3-5]. The prevalence rate in children is based upon screening tests performed on a nationally representative sample . In comparison, the frequency of cases that are clinically identified is far lower (5 percent of the expected number), suggesting that screening for and case identification of pediatric HCV are grossly inadequate . The proportion of children who are HCV antibody-positive who are also HCV RNA positive is not known precisely; based upon studies in adults, it is estimated to be approximately 75 to 80 percent. (See "Epidemiology and transmission of hepatitis C virus infection".)
The prevalence is much higher (50 to 95 percent) in individuals who received blood products for conditions such as thalassemia or hemophilia before 1990 (when a first-generation enzyme-linked immunosorbent assay [ELISA] test became available and routine screening of the blood supply began) to as late as 1992 (when the second-generation ELISA test was introduced) [7-9]. Seroprevalence rates of 10 to 20 percent were reported among children with a variety of other potential exposures such as malignancy, hemodialysis, extracorporeal membrane oxygenation, or surgery for congenital heart disease in the early to mid-1990s [10-15]. A 2 percent seroprevalence rate was found in an incarcerated juvenile population in Washington, DC . Most of these at-risk children are now young adults, as routine testing of the blood supply in developed countries has virtually eliminated transmission via this route.
There appears to be worldwide geographic variation in the prevalence of HCV infection in children, the reasons for which are incompletely understood. Studies in the early 1990s (which reflected populations of children who could have been exposed to contaminated blood products) reported prevalence rates ranging from 0 percent in Japan and Taiwan [17,18], 0.4 percent in Italy , 0.6 percent in Malaysia , 0.9 percent in Saudi Arabia , 1.4 percent in Moldova , and up to 14.5 percent in Cameroon . Prevalence rates in Egypt were low in the 1990s among children without a history of exposure to blood products , but series from 2007 reported infection in 2 percent . No data on prevalence in childhood are available.
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- NATURAL HISTORY
- Spontaneous clearance
- Advanced disease
- Factors associated with disease progression
- - Perinatal transmission
- - Other
- EVALUATION AND MONITORING
- HCV genotyping
- Liver biopsy
- - Indications
- - Histology
- Serum aminotransferases
- ACUTE INFECTION
- TREATMENT OF CHRONIC HCV
- Pediatric trials
- Decision to treat
- Prevention of transmission
- Minimizing risk for disease progression
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS