A policy statement on hepatitis C virus from the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) calls for the screening of all persons who have risk factors for hepatitis C virus infection to identify those who may have the disease. Hepatitis C virus infection is a leading cause of chronic liver disease. In the policy statement, the AAP recommends the screening of all infants born to infected mothers, as well as the screening of children with risk factors for the disease. The AAP does not recommend routine testing for pregnant women.
The statement, published in the March 1998 issue of Pediatrics, includes discussions on how hepatitis C virus is transmitted (exposure to blood and blood products, sexual transmission, maternal-infant transmission and household contact with an infected person), the major types of diagnostic tests, treatment, management of exposed persons, and future directions. A summary of the recommendations is also included.
According to the AAP, the seroprevalence of hepatitis C virus infection is 1.8 percent in the general population of the United States; among children, it is 0.2 percent for those younger than 12 years of age and 0.4 percent for those 12 to 19 years of age. Seroprevalence rates of 1 to 2 percent have been found in pregnant women.
Persons who are at highest risk for infection with hepatitis C virus include intravenous drug users and persons who received blood transfusions before 1992 or organ transplants from infected donors; these groups account for 60 to 90 percent of all cases of hepatitis C virus infection. Sexual transmission accounts for 5 percent of all cases of hepatitis C virus infection, and 4 percent of cases are from household contact. When person-to-person transmission does occur in a household, it is most likely the result of direct contact with blood.
The AAP notes that the U.S. Public Health Service has recommended that persons who received Gammagard or Polygam between April 1, 1993, and February 23, 1994, be offered screening for hepatitis C virus infection. PCR testing for hepatitis C virus RNA is recommended for persons with elevated alanine aminotransferase levels who are negative for antibodies to hepatitis C virus on repeated testing.
Interferon alfa-2b is the only product approved for the treatment of chronic hepatitis C virus infection in adults (see editor's note at end of text), and only 10 to 15 percent of patients have a sustained response. Unlike treatment recommendations in adults, data are insufficient to recommend treatment for infected children. However, the AAP does not support exclusion of chronically infected children from child care settings. Children with symptomatic disabling disease or histologically advanced pathologic conditions should be referred to a specialist experienced with hepatitis C virus infection in children. The policy statement does recommend hepatitis A and B vaccination of chronic carriers to prevent additional liver damage and referral to appropriate physician specialists.
Patients with hepatitis C virus infection should be counseled to avoid hepatotoxic medications and alcohol. All of these patients should be considered infectious and be informed of the possibility of transmission to others. Infected persons should be followed at regular intervals by a physician familiar with tests required to monitor for evidence of chronic hepatitis. Children with hepatitis C virus infection are at risk of developing serious liver diseases as they get older, including hepatocellular carcinoma. All children who are known to be chronically infected should receive periodic screening.
editor's note: Since this AAP statement was published, a combination therapy (Rebetron) containing interferon alfa-2b and ribavirin has been approved for the treatment of individuals with unresponsive hepatitis C infection.