As hepatitis C virus (HCV) is increasing among pregnant women, exposing infants to HCV infection, these infants are not adequately screened and their infections remain undetected, said a study by Magee-Womens Research Institute (MWRI).
The National Center for Biotechnology Information said at least 40,000 children are exposed to HCV during pregnancy annually in the United States, resulting in an estimated 2,700 to 4,000 new cases of pediatric HCV infections each year.
Last year's data on the global hepatitis C epidemic, released by the World Hepatitis Summit in Sao Paulo, Brazil (1-3 November, 2017) revealed that most countries with high-income are running out of patients to treat because of the low diagnosis rates worldwide.
Globally, just one in five patients with hepatitis C knows they are infected and the proportion ranges from 44% across high-income countries down to just 9% across low-income countries. Though a record 1.76 million people with hepatitis C were treated in 2016, countries cannot hope to achieve elimination without boosting diagnosis rates.
Like hepatitis B infection, perinatal transmission is the primary cause of HCV infection in children and approximately 80 percent of children who acquired it through mothers develop chronic infection.
"Without appropriate screening, children at risk for perinatal transmission may remain undiagnosed until the child becomes symptomatic or has abnormal liver enzyme testing found incidentally," said senior author Catherine Chappell from the UPMC Magee-Womens Hospital. "Delays in diagnosis could lead to delays in appropriate referrals and curative treatment, or even irreversible liver disease, such as cirrhosis or hepatocellular carcinoma."
Chappell and her team analyzed the data at Magee between 2006 and 2014, using data from the Magee Maternal and Infant (MOMI) database on all births at the hospital from 1995.Among the 1,025 HCV-exposed infants, 31 percent received well-child services and among these, only 30 percent were screened for HCV.
"Between 2006 and 2014, HCV prevalence increased by 60 percent. This is a wakeup call for providers to be aware of the increased risk of HCV in pregnant women and the affects it could have on their babies," Chappell said. "While more research needs to be done on why screening rates are so low, it is important providers are properly testing for HCV, especially in high prevalence areas, and that we have programs focused on identifying pregnant women with HCV during prenatal care."
The results are published in the journal Pediatrics on Tuesday (April 1, 2018).
"Hepatitis C is a silent killer and there are nearly 70 million people worldwide who need treatment, but we must find them," said Charles Gore, President of the World Hepatitis Alliance.
"Yet, because of the historic lack of national and international investment in viral hepatitis programmes, the vast majority of patients with hepatitis C - some 80% --remain undiagnosed, and less than 5% are able to access treatment."
The data, released by the CDA Foundation's Polaris Observatory* (led by Dr Homie Razavi in Lafayette, CO, USA), show that new diagnoses of hepatitis C must triple from 1.5 million to 4.5 million each year and treatment rates from 1.76 million to 5 million in order achieve WHO's elimination targets by 2030.
"We have the right to know if we are living with a cancer-causing virus" said Raquel Peck, CEO of World Hepatitis Alliance. "In addition to the need for people to be diagnosed to access treatment, a high proportion of the 1.5 million new hepatitis C infections last year could have been avoided if people were aware of their health status."
To confront this challenge a number of countries are using innovative strategies to improve their diagnosis rates, from testing at dental appointments and in hospital emergency rooms to screening entire villages, alongside offering financial incentives.
In Egypt, the entire village of El Othmanya (population 3,500 people) was screened, with 215 cases of hepatitis C detected. So far, this same methodology has now been extended to 50 villages in 26 regions of Egypt, as the country targets screening 30 million of its 90 million population by the end of 2018.
In New Zealand's remote Northland region, the local health board provided NZ$300 to general practices for each patient successfully diagnosed and treated for hepatitis C infection, allowing them to waive the co-payment fees that patients are required to pay for doctors' appointments. The New Zealand government has also recently announced a nationwide programme to pay the medical transport costs of all people with hepatitis C.
In Chicago, USA, Mount Sinai Hospital ran a program up to March 2017 that automatically screened any patient over 16 years entering the emergency department and needing blood tests. This resulted in a diagnosis of nearly 200 patients with hepatitis C in the six-month program.
Emergency room screening is also helping detect some 70% of new cases in the Cherokee Nation American Indian Tribe in Oklahoma, USA, which has its own elimination plan. All patients visiting the doctor or the dentist are also offered a test for hepatitis C.
"Only with a combination of political will, increased access to diagnostics and greater awareness of the disease can we vastly improve diagnosis rates," says Dr Razavi. "Unless we crack this diagnosis challenge, the ambitious elimination targets for hepatitis set by WHO will remain out of reach for decades to come."
