Hepatitis C

I care for a newborn whose mother has hepatitis C. What is the risk of transmission of hepatitis C to the baby, and how should I follow this infant?

Hepatitis C is a very common viral infection in the United States. It is estimated that 0.5 to 1.5% of all adults may be infected with hepatitis C. Thus, it is likely that this scenario will occur in the primary care setting. Infants born to mothers who have hepatitis C have an approximately 5% chance of acquiring hepatitis C vertically. If testing has been done on the mother, it is helpful to know whether or not she is viremic, as determined by a HCV PCR. In mothers who are HCV PCR negative, the risk of vertical transmission of hepatitis C is very low.

Follow up of the infant could follow one of two scenarios. We generally recommend testing the infant for the presence of the virus by HCV PCR at 3 and 9 months of age, with a follow up HCV antibody determination at 18-24 months of age. If these are negative, then the infant has not acquired hepatitis C. If the PCR is positive early on, there is an approximately 25% chance of clearing the virus within the first two years of life. Checking an HCV antibody before 15-18 months of age may lead to a false positive result as the maternal HCV antibody crosses the placenta, and will not be indicative of the status of the infant’s potential infection with hepatitis C. An alternative approach is to wait until the infant is 18 months of age and check an HCV antibody at that time.

If the HCV PCR is positive, LFTs should be followed. Referral to the Pediatric Liver Center would certainly be appropriate at this point for education and follow up.

The following serologic testing would be appropriate for acute viral hepatitis:

• Hepatitis A:  Hepatitis A IgM (anti-HAV AB IgM)
• Hepatitis B:  Hepatitis B surface antigen (HBsAg) with or without a hepatitis B core IgM (anti-HBcIgM)
• Hepatitis C:  In most settings, an anti-HCV antibody is sufficient for testing for hepatitis C. There are rare circumstances where an anti-HCV AB can be negative, and an HCV PCR may be required. However, acute hepatitis C is actually quite rare in children, particularly if there are no identifiable risk factors (infant of a mother with hepatitis C, IV drug use, a known exposure or high risk setting).
• Hepatitis E:  Hepatitis E IgM (anti-HEV IgM) Hepatitis E has only been reported in individuals with recent travel to an endemic region (Mexico , India ). This disease very rare and is very similar clinically to hepatitis A.