In the Journals

Estimated global prevalence of pediatric HCV at more than 3 million

Homie Razavi
Homie Razavi

An analysis of peer-reviewed articles provided global prevalence estimates of hepatitis C virus in children, according to data from a modelling study.

“Although we could not establish causation in our study, it does suggest that prevention of HCV infection among children will require what the World Health Organization and international guidelines have already outlined — find and treat more patients and implement harm reduction programs,” Homie Razavi, PhD, the managing director at the Center for Disease Analysis Foundation, told Healio Gastroenterology and Liver Disease.

Razavi and colleagues conducted a comprehensive literature review of peer-reviewed articles published between January 2000 and March 2019 that reported HCV prevalence estimates for children (18 years or younger) in all 249 countries and territories of the world.

They identified HCV prevalence estimates for children who were not at high risk for HCV in 39 countries and territories, then used those data to create Markov disease-burden models to estimate HCV prevalence in 2018.

Twenty-five countries and territories had complete data on HCV prevalence in children, which investigators used to build regression models to predict pediatric prevalence in 65 additional countries and territories that only had country-specific or territory-specific data about predictors. Researchers then created regression models for each 5-year pediatric age cohort from 0 to 19 years, using several predictor variables.

The investigators then used the data and forecasts from the 104 countries and territories that had data available to calculate HCV prevalence by Global Burden of Disease region, which they applied to the remaining 145 countries and territories to generate a global estimate.

Results showed the estimated 2018 global HCV prevalence in the pediatric population was 0.13% (95% uncertainty interval, 0.08-0.16), corresponding to 3.26 million children with HCV. Further, HCV prevalence in adults was associated with HCV infection in children and HCV prevalence in women of childbearing age was a strong predictor for prevalence in children aged 0 to 4 years.

“A significant number of children are infected with hepatitis C globally and the best predictor of their infection rate is HCV infection among adults,” Razavi said. “If more adults are infected in a country, then more children will also be infected.”

Razavi and colleagues wrote that this analysis further reveals the important association of HCV infection in adults and in children. Estimating the number of children who are screened, diagnosed, linked to care and are eligible for treatment may aid in screening and treatment scale-ups, according to the researchers.

“Before this study, I did not fully appreciate the continued risk of infections among children as they grow,” Razavi said. “Older age groups always had a higher infection rather than younger ones, indicating that children are getting infected as they age. All of these infections are preventable by screening and treating women of childbearing age.”

Key actions such as calculating and recognizing the magnitude of the problem may address the current policy gaps and achieve treatment scale-up comparable to that in adults, Sabela Lens, MD, a hepatologist in the liver unit at the Hospital Clinic of Barcelona at the University of Barcelona, and Jeffrey V. Lazarus, a professor at the Barcelona Institute for Global Health Hospital Clinic at the University of Barcelona, wrote in an accompanying editorial.

New large and age-specific national HCV prevalence studies are needed, but the scarcity of information should not restrict efforts to eliminate viral hepatitis as a public health threat, the authors added.

“The results of the analysis by Schmelzer and colleagues make it clear that the pediatric population cannot continue to be ignored, as there might be many more than 3 million children infected with HCV globally,” Lens and Lazarus wrote. – by Erin T. Welsh

Disclosures: Razavi reports receiving grants from Gilead Sciences, the John C. Martin Foundation and private donors during the conduct of the study. Lens reports receiving grants and personal fees from Gilead and personal fees from AbbVie, Janssen and MSD. Lazarus reports receiving grants, personal fees and conference travel grants from AbbVie, Cepheid, Gilead, Janssen and MSD. Please see the full study for all other authors’ relevant financial disclosures.

Homie Razavi
Homie Razavi

An analysis of peer-reviewed articles provided global prevalence estimates of hepatitis C virus in children, according to data from a modelling study.

“Although we could not establish causation in our study, it does suggest that prevention of HCV infection among children will require what the World Health Organization and international guidelines have already outlined — find and treat more patients and implement harm reduction programs,” Homie Razavi, PhD, the managing director at the Center for Disease Analysis Foundation, told Healio Gastroenterology and Liver Disease.

Razavi and colleagues conducted a comprehensive literature review of peer-reviewed articles published between January 2000 and March 2019 that reported HCV prevalence estimates for children (18 years or younger) in all 249 countries and territories of the world.

They identified HCV prevalence estimates for children who were not at high risk for HCV in 39 countries and territories, then used those data to create Markov disease-burden models to estimate HCV prevalence in 2018.

Twenty-five countries and territories had complete data on HCV prevalence in children, which investigators used to build regression models to predict pediatric prevalence in 65 additional countries and territories that only had country-specific or territory-specific data about predictors. Researchers then created regression models for each 5-year pediatric age cohort from 0 to 19 years, using several predictor variables.

The investigators then used the data and forecasts from the 104 countries and territories that had data available to calculate HCV prevalence by Global Burden of Disease region, which they applied to the remaining 145 countries and territories to generate a global estimate.

Results showed the estimated 2018 global HCV prevalence in the pediatric population was 0.13% (95% uncertainty interval, 0.08-0.16), corresponding to 3.26 million children with HCV. Further, HCV prevalence in adults was associated with HCV infection in children and HCV prevalence in women of childbearing age was a strong predictor for prevalence in children aged 0 to 4 years.

“A significant number of children are infected with hepatitis C globally and the best predictor of their infection rate is HCV infection among adults,” Razavi said. “If more adults are infected in a country, then more children will also be infected.”

Razavi and colleagues wrote that this analysis further reveals the important association of HCV infection in adults and in children. Estimating the number of children who are screened, diagnosed, linked to care and are eligible for treatment may aid in screening and treatment scale-ups, according to the researchers.

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“Before this study, I did not fully appreciate the continued risk of infections among children as they grow,” Razavi said. “Older age groups always had a higher infection rather than younger ones, indicating that children are getting infected as they age. All of these infections are preventable by screening and treating women of childbearing age.”

Key actions such as calculating and recognizing the magnitude of the problem may address the current policy gaps and achieve treatment scale-up comparable to that in adults, Sabela Lens, MD, a hepatologist in the liver unit at the Hospital Clinic of Barcelona at the University of Barcelona, and Jeffrey V. Lazarus, a professor at the Barcelona Institute for Global Health Hospital Clinic at the University of Barcelona, wrote in an accompanying editorial.

New large and age-specific national HCV prevalence studies are needed, but the scarcity of information should not restrict efforts to eliminate viral hepatitis as a public health threat, the authors added.

“The results of the analysis by Schmelzer and colleagues make it clear that the pediatric population cannot continue to be ignored, as there might be many more than 3 million children infected with HCV globally,” Lens and Lazarus wrote. – by Erin T. Welsh

Disclosures: Razavi reports receiving grants from Gilead Sciences, the John C. Martin Foundation and private donors during the conduct of the study. Lens reports receiving grants and personal fees from Gilead and personal fees from AbbVie, Janssen and MSD. Lazarus reports receiving grants, personal fees and conference travel grants from AbbVie, Cepheid, Gilead, Janssen and MSD. Please see the full study for all other authors’ relevant financial disclosures.