Earlier Identification of HCV in Young Women, Babies Needed

Janis C. Kelly

July 26, 2016

The fast-growing epidemic of opioid abuse, which, according to the Centers for Disease Control and Prevention (CDC), led to a tripling of overdose deaths between 2010 and 2014, has also begun to threaten young mothers and their babies with liver-destroying hepatitis C virus (HCV). Public health researchers warned this week that "[i]ncreases in the rate of HCV detection among women of childbearing age suggest a potential risk for vertical transmission of HCV."

Alaya Koneru, MPH, and colleagues report in the July 22 issue of the Morbidity and Mortality Weekly Report that the national rate of hepatitis C infection among women of childbearing age (15 - 44 years old) increased by 22% from 2011 to 2014, and that the rate of infants born to HCV-infected women increased by 68%. Past or current injection drug use was reported by 38% of the HCV-infected women in Kentucky, the state with the highest rate of new HCV infections.

The authors write, "CDC recommends HCV testing for persons with a history of injection drug use and others at risk, including persons infected with HIV and persons with recognized exposures (e.g., health care workers after needle sticks or mucosal exposure to HCV-positive blood). It is important that providers assess women of childbearing age, particularly pregnant women, for HCV risk and test accordingly. CDC also recommends HCV testing of children born to HCV-infected women."

The American Association for the Study of Liver Disease, the American Academy of Pediatrics, and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition have all issued clinical guidance on diagnosis and treatment of HCV in infants and children.

Koneru, from the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia, and colleagues in the Kentucky Department for Public Health and at Quest Diagnostics, Madison, New Jersey, evaluated HCV infection in women of childbearing age and potential mother-to-child transmission both nationally and for Kentucky. They analyzed commercial laboratory HCV test data from Quest Diagnostics, birth certificate data from the National Center for Health Statistics, and demographic data reported to the Kentucky Department of Public Health during 2011 to 2014 for HCV antibody-positive pregnant women as part of routine acute HCV surveillance.

They used data for children aged 2 years and younger to estimate the population at risk for vertical HCV transmission. The researchers explain, "Detection of HCV infection among infants was not evaluated because 1) the exact infant dates of birth to allow discrimination between maternal and infant HCV antibody were not available, and 2) very few infants had RNA testing to detect current HCV infection."

Based on Quest data, during 2011 to 2014, the national rate of HCV detection among women of childbearing age increased from 139 to 169 per 100,000, and the proportion of children aged 2 years and younger tested for HCV increased from 310 to 353 per 100,000.

Also during 2011 to 2014, the HCV rate in women of childbearing age in Kentucky increased by 213% (from 275 to 862 per 100,000), and the rate of testing of children aged 2 years and younger increased 151% (from 403 to 1011 per 100,000). During this period, the proportion of infants born to HCV-infected women in Kentucky increased 124%, from 1 in 142 to 1 in 63.

Of the 777 pregnant, HCV-positive women identified in Kentucky, most were non-Hispanic white (84%) and aged between 20 and 29 years (68%). Two hundred eighteen (28%) were aged 30 to 39 years, and 293 (38%) reported past or current injection drug use. The authors note that this illustrates higher risk in certain areas of the United States, particularly in rural areas such as Appalachia. They also note that these estimates almost certainly underestimate the incidence of HCV infection because HCV case reporting is not mandatory in all states.

The authors suggest that routine HCV testing of infants identified as having perinatal exposure to drugs or neonatal abstinence syndrome and their mothers could improve HCV case identification and treatment. They also highlight the urgent need for establishing a single set of testing guidelines for children born to HCV-infected women, for a standardized perinatal HCV case definition, and for programs to identify and treat HCV-infected women before pregnancy, as there is currently no way to prevent maternal–fetal transmission of the virus.

Two coauthors are employees of Quest Diagnostics. The other authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2016;65:705-710. Full text

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