In The News: New HCV Testing Guidelines Aim to Increase Screening Among Exposed Infants

Healio reports on research into perinatal Hepatitis C virus exposure among U.S. infants, published in the Journal of the Pediatric Infectious Diseases Society. In the span of 2010-2020, less than half (47%) of perinatally exposed infants had received testing for HCV. Over nearly the same time span, HCV infections quadrupled from 0.3 per 100,000 in 2009 to 1.2 per 100,000 in 2018. Infection rates were 3.1 per 100,000 for those 20-29 years of age.

The Centers for Disease Control and Prevention introduced new guidelines in 2020 that recommend HCV screening for every pregnancy, and further testing of exposed infants after age 18 months to check for HCV antibodies. The estimated risk of HCV (and HIV) transmission during pregnancy, according to study authors, is between 7.2% and 12.1%. In their retrospective study, however, researchers found less than half had been tested, despite the guideline.

In a national retrospective study from the same time span, researchers identified what test, if any, infants were given, and whether children in need received antiviral treatment. Among the 8,516 exposed, 45.8% were tested for HCV with 42.1% were appropriately tested. Of the appropriately tested, 51.3% received antibody testing, 24.6% received RNA testing, and 24.1% received both antibody and RNA testing. There were 104 eligible for treatment at three years of age, but only 15 were.

Racial and ethnic disparities existed in testing. Researchers found Black and Asian/Pacific Islander children significantly less likely to receive appropriate testing compared to their white counterparts. Hispanic children were less likely to receive appropriate testing compared to non-Hispanic children.

CDC began recommending early testing in 2023. The recommendations are to administer an RNA test to exposed children between ages 2 and 6 months, or up to age 17 months if they not previously tested. Children 18 months or older should receive an antibody test if no previous test history.

PIDS members and authors of the studies, Ezzeldin Saleh and Rachel Epstein, are quoted in the article. Dr. Saleh said, “The hope is that earlier and simple one-step testing will maximize the chances of testing all exposed children as they are seen for well-child visits around the same time. Previous recommendations for testing after 18 months of age had led to a significant number of exposed children being lost to follow-up.” And Dr. Epstein remarked, “General pediatricians are the first line in ensuring all infants exposed to hepatitis C virus are tested. Now that universal hepatitis C testing is recommended in pregnancy, pediatricians should ensure that maternal testing is checked and create a workflow to routinely test exposed infants with RNA testing at 2 to 6 months of age and make appropriate referrals for those testing positive.”