Thus far, no guidelines for prevention of perinatal transmission have been put forth.
Injectable drug use is the most common route of hepatitis C acquisition — and in the current opioid epidemic, infection rates are escalating. The CDC reports that during 2011–2014, rates of hepatitis C detection in U.S. women of childbearing age (range,15–44) increased 22%, hepatitis C testing of children aged ≤2 years increased 14%, and the proportion of children born to hepatitis C–infected women rose from 0.19% to 0.32%. Vertical transmission of hepatitis C occurs in 5.8% of infants born to infected women.
In Kentucky, a state particularly affected by drug use, rates of hepatitis C detection in women of childbearing age increased 3-fold, and testing of children for hepatitis C increased 2.5-fold. Concurrently, the proportion of infants born to women with hepatitis C rose from 0.72% to 1.59%.
Comment
Given the rising rates of hepatitis C infection in childbearing-aged women, we are likely to see more infants with hepatitis C. The good news is that antiviral therapy for hepatitis C is very effective, and initial studies suggest it is safe in children. The bad news is that the price tag for this therapy is out of reach for many. Thus far, no guidelines for prevention of perinatal transmission have been put forth, and public health recommendations for routine screening for hepatitis C in pregnancy are lacking (although such testing is encouraged for women with acknowledged risk factors). Needle exchange programs might stem the epidemic (much as reported for the recent HIV outbreak in Indiana (NEJM JW Infect Dis Jun 2015 and MMWR Morb Mortal Wkly Rep 2015; 64:1), but are not politically encouraged in the U.S.
Editor Disclosures at Time of Publication
Disclosures for Anna Wald, MD, MPH at time of publication Consultant / Advisory board AiCuris; Merck (DSMB) Royalties UpToDate Grant / Research support NIH/National Cancer Institute; NIH/National Institute of Allergy and Infectious Diseases; Genocea Biosciences; Vical Editorial boards Sexually Transmitted Diseases; Sexually Transmitted Infections Leadership positions in professional societies International Society for Sexually Transmitted Diseases Research (Board Member)
Citation(s):
Koneru A et al. Increased hepatitis c virus (HCV) detection in women of childbearing age and potential risk for vertical transmission — United States and Kentucky, 2011–2014. MMWR Morb Mortal Wkly Rep 2016 Jul 22; 65:705.
Injectable drug use is the most common route of hepatitis C acquisition — and in the current opioid epidemic, infection rates are escalating. The CDC reports that during 2011–2014, rates of hepatitis C detection in U.S. women of childbearing age (range,15–44) increased 22%, hepatitis C testing of children aged ≤2 years increased 14%, and the proportion of children born to hepatitis C–infected women rose from 0.19% to 0.32%. Vertical transmission of hepatitis C occurs in 5.8% of infants born to infected women.
In Kentucky, a state particularly affected by drug use, rates of hepatitis C detection in women of childbearing age increased 3-fold, and testing of children for hepatitis C increased 2.5-fold. Concurrently, the proportion of infants born to women with hepatitis C rose from 0.72% to 1.59%.
Comment
Given the rising rates of hepatitis C infection in childbearing-aged women, we are likely to see more infants with hepatitis C. The good news is that antiviral therapy for hepatitis C is very effective, and initial studies suggest it is safe in children. The bad news is that the price tag for this therapy is out of reach for many. Thus far, no guidelines for prevention of perinatal transmission have been put forth, and public health recommendations for routine screening for hepatitis C in pregnancy are lacking (although such testing is encouraged for women with acknowledged risk factors). Needle exchange programs might stem the epidemic (much as reported for the recent HIV outbreak in Indiana (NEJM JW Infect Dis Jun 2015 and MMWR Morb Mortal Wkly Rep 2015; 64:1), but are not politically encouraged in the U.S.
Editor Disclosures at Time of Publication
Disclosures for Anna Wald, MD, MPH at time of publication Consultant / Advisory board AiCuris; Merck (DSMB) Royalties UpToDate Grant / Research support NIH/National Cancer Institute; NIH/National Institute of Allergy and Infectious Diseases; Genocea Biosciences; Vical Editorial boards Sexually Transmitted Diseases; Sexually Transmitted Infections Leadership positions in professional societies International Society for Sexually Transmitted Diseases Research (Board Member)
Citation(s):
Koneru A et al. Increased hepatitis c virus (HCV) detection in women of childbearing age and potential risk for vertical transmission — United States and Kentucky, 2011–2014. MMWR Morb Mortal Wkly Rep 2016 Jul 22; 65:705.
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