Hepatitis C is an RNA virus. It is spread by blood and bodily fluids. No vaccine is available. It is now curable in adults, using direct acting antiviral medications. These treatments are not yet available for children.
Disease Course
In adults:
- 1 in 4 fight off the virus and make a full recovery
- 3 in 4 develop chronic hepatitis C
Complications:
- Liver cirrhosis and associated complications of cirrhosis
- Hepatocellular carcinoma
Vertical Transmission
Hepatitis C is passed from infected mothers to their babies about 5 – 15% of the time. Hepatitis C antivirals are not recommended in pregnancy and there are no additional measures that are known to reduce the risk of transmission.
Babies and children tend not to have any symptoms or pathology associated with hepatitis C infection. It is very unlikely that children will pass on hepatitis C to others as they do not engage in sexual activity or IV drug use. Parents should be educated about hepatitis C and the modes of transmission.
Testing
- Hepatitis C antibody is the screening test
- Hepatitis C RNA testing is used to confirm the diagnosis of hepatitis C, calculate viral load and identify the genotype
Management in Children
Babies to hepatitis C positive mothers are tested at 18 months of age using the hepatitis C antibody test. Breastfeeding has not been found to spread hepatitis C, so mothers are free to breastfeed their babies. If nipples become cracked or bleed breastfeeding should temporarily stop whilst they heal.
Children often clear the virus spontaneously. Chronic infection with hepatitis C does not usually cause issues in childhood. Infected children will require regular specialist follow up to monitor their liver function and hepatitis C viral load.
Medical treatment may be considered in children over 3 years. Treatment in childhood involves pegylated interferon and ribavirin, which are less effective and well tolerated compared with the adult treatments.
Treatment is typically delayed until adulthood unless the child is significantly affected, because children are usually asymptomatic and newly available treatment for adults is highly effective.
Last updated January 2020