In the JournalsPerspective

Few Infants Born to Mothers with HCV in Philadelphia Undergo Testing

More than 80% of infants born to mothers with HCV go untested for vertical transmission in the Philadelphia area, according to recent research in Clinical Infectious Diseases.

“Our findings demonstrate that many health care providers remain unaware of both the risks of perinatal HCV transmission and the recommended protocols for testing exposed infants,” Danica E. Kuncio, MPH, hepatitis epidemiologist for the Philadelphia Department of Public Health, told Infectious Diseases in Children. “Although there is HCV testing being performed on women of child-bearing age, positive results are still not being appropriately relayed to pediatricians.

Laura Kunico

Danica E. Kuncio

“This break in communication means that a high proportion of HCV-positive children remain unidentified and out of care for their HCV infection. Improving infant testing rates will be especially critical once direct-acting antiviral agents against HCV are approved for pediatric use.”

Kuncio and colleagues analyzed data from an electronic hepatitis registry, a database reported to the city’s health department that monitors HCV-positive patients. Birth certificates for 2011 to 2013 were matched with HCV data to identify the testing status of children aged 20 months or older. The researchers also retrospectively examined additional tests, including negative results. Results were compared with the expected vertical HCV transmission rate of 5% to estimate the number of children with unidentified HCV infections.

Study data revealed that 500 women registered with the HCV dataset gave birth to one or more children from 2011 to 2013. Of the 537 at-risk children born during this period, only 16% were tested for HCV infection, resulting in four confirmed cases. Based on comparisons to the expected rate of infection, the researchers estimated that there are 24 unidentified children with chronic HCV infection.

“It is important for both patients and providers to be aware of the risks of vertical HCV transmission, and to understand the steps required to identify children perinatally infected with HCV,” Kuncio and colleagues wrote. “As a part of standard health care, women should be encouraged to communicate their HCV infection statuses to relevant providers. In addition, health care providers of mother and child must … adequately test every child who is exposed to HCV.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.

More than 80% of infants born to mothers with HCV go untested for vertical transmission in the Philadelphia area, according to recent research in Clinical Infectious Diseases.

“Our findings demonstrate that many health care providers remain unaware of both the risks of perinatal HCV transmission and the recommended protocols for testing exposed infants,” Danica E. Kuncio, MPH, hepatitis epidemiologist for the Philadelphia Department of Public Health, told Infectious Diseases in Children. “Although there is HCV testing being performed on women of child-bearing age, positive results are still not being appropriately relayed to pediatricians.

Laura Kunico

Danica E. Kuncio

“This break in communication means that a high proportion of HCV-positive children remain unidentified and out of care for their HCV infection. Improving infant testing rates will be especially critical once direct-acting antiviral agents against HCV are approved for pediatric use.”

Kuncio and colleagues analyzed data from an electronic hepatitis registry, a database reported to the city’s health department that monitors HCV-positive patients. Birth certificates for 2011 to 2013 were matched with HCV data to identify the testing status of children aged 20 months or older. The researchers also retrospectively examined additional tests, including negative results. Results were compared with the expected vertical HCV transmission rate of 5% to estimate the number of children with unidentified HCV infections.

Study data revealed that 500 women registered with the HCV dataset gave birth to one or more children from 2011 to 2013. Of the 537 at-risk children born during this period, only 16% were tested for HCV infection, resulting in four confirmed cases. Based on comparisons to the expected rate of infection, the researchers estimated that there are 24 unidentified children with chronic HCV infection.

“It is important for both patients and providers to be aware of the risks of vertical HCV transmission, and to understand the steps required to identify children perinatally infected with HCV,” Kuncio and colleagues wrote. “As a part of standard health care, women should be encouraged to communicate their HCV infection statuses to relevant providers. In addition, health care providers of mother and child must … adequately test every child who is exposed to HCV.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Jessica Wen

    Jessica Wen

    We are doing a poor job at screening babies born to mothers with hepatitis C virus infection.

    Mother-to-infant transmission is the major route of transmission for HCV in children. However, HCV is not routinely screened in pregnant women. Rather, it is based on self-reporting of risk factors, such as IV drug use. In the Philadelphia study, a disappointing 16% of children born to HCV-infected women had any HCV testing, and less than half of those had adequate testing. This indicates inadequate communication of maternal HCV status to the pediatricians caring for these infants as well as a knowledge gap for adequately testing children at-risk for HCV infection.

    Mothers with HCV infection may choose not to disclose infection due to fear of consequences or lack of knowledge for need to disclose. Many may be unaware of their own HCV status, especially with the recent surge of HCV in young people due to increased IV drug use. Furthermore, children may be taken care of by family members or adopted due to unstable social situations. All of these contribute to the lack of maternal screening as well as communication of maternal HCV status to the pediatricians.

    Additionally, many pediatricians are not familiar with screening guidelines. This may be contributed by the perception of the slow progressive nature of HCV in children, lack of effective treatment (prior to development of direct-acting antivirals) and relative low transmission rate. Now with the availability of highly effective treatments, it would be important that these children are screened and diagnosed so that they can be cured of HCV infection before disease progression. To accomplish this, we need broader education of providers. We may also need to consider earlier screening with RNA-based testing rather than delaying screening until 18 months of age, particularly in situations where reliable follow-ups are not ensured.

    • Jessica Wen, MD
    • Assistant professor of pediatrics The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine

    Disclosures: Wen reports research support from AbbVie, Bristol-Myers Squibb and Gilead Sciences.