Children with hepatitis C

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Children with hepatitis C

Children with hepatitis C

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How Many Children In The US Are Infected With HCV ?

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The stats are between 0.2 percent and 0.4 in the US.

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From Healthday;

The University of Miami School of Medicine found based on that data, they thought they would find about 12,155 cases of pediatric infection in Florida, yet only 1,755 cases were identified, a mere 14.4 percent of the expected number of cases.

"Our study showed a lack of adequate identification of hepatitis C virus infection in children that could be widespread throughout the nation," said lead researcher Dr. Aymin Delgado-Borrego, a pediatric gastroenterologist and assistant professor of pediatrics.

Based on these data, Delgado-Borrego's group found only about 1.2 percent of children with hepatitis C were receiving treatment by a pediatric hepatologist.

Most young children get the infection from their mothers while in the womb. That accounts for about 60 percent of the infections in young children, Delgado-Borrego said. Teenagers can get it through IV drug use and other substance abuse, she added.

"Primary care doctors should screen all children who are at risk for hepatitis C infection, such as those whose mothers are infected," Delgado-Borrego said.

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What Are The Rates Of Infection From Mother To Child ?

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The Good News

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Vertical transmissionVertical transmission refers to the transmission of a communicable disease from an infected mother to her child during the birth process. Mother-to-child transmission of hepatitis C has been well described, but occurs relatively infrequently. Transmission occurs only among women who are HCV RNA positive at the time of delivery; the risk of transmission in this setting is approximately 6 out of 100. Among women who are both HCV and HIV positive at the time of delivery, the risk of transmitting HCV is increased to approximately 25 out of 100..l

PREGNANCY: From hepc.bull -monthly newsletter

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If a baby is born to an HCV+ mother and its blood is tested at birth for hepatitis C antibodies, the test would come back positive. This is because the baby has some of its mother’s antibodies. The antibodies clear naturally over time. A test at 12months usually confirms whether or not a toddler has the virus. About one third of babies test positive for the virus when tested at the age of 3 days. Method of delivery made little or no difference. The rate of fetal infections in HCV+ can be zero and up to 10%. The rate goes up if the mother is co-infected with HIV.

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Present information shows that transmission may be more likely;

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In infants born to mothers with genotype 1.

(Obstet GynecolSurv. 2005 Sep;60(9):572-574)

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Any woman, or partner of a man, who has taken ribavirin must wait 6 months after the end of treatment before becoming pregnant to avoid birth defects.

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The risk of vertical transmission of HCV does not appear to be associated with method of delivery or breastfeeding.

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There has been no documented case of HCV being transmitted by breastfeeding, and the rates of infant infection are identical in both breast fed and bottle-fed infants.

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There are many advantages to breast feeding. Breast feeding mothers should check their nipples before each feed and avoid breastfeeding if they are cracked or bleeding. They may want to consider using breast shields. It is not known if interferon or ribavirinis passed on to the baby through breastmilk. Circulating HCV RNA does not increase pregnancy complications.

A substantial proportion of pregnant women with hepatitis C virus infection have circulating HCV RNA, even when they are asymptomatic, however these women do not have an increased risk of obstetric complications and pregnancy does not appear to induce symptomatic liver disease. “There is no risk to the outcome of pregnancy in an anti-HCV positive pregnant mother.

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The majority of pregnant women have normal transaminase levels during the course of pregnancy, although a substantial proportion has circulating HCV RNA. Pregnancy does not induce deterioration of liver disease, and HCV infection does not increase the risk of obstetric complications.†(“HCV Infectionin Pregnancy,†British Journal of Obstetricsand Gynecology, 1996;103:325-329)

,There is a high mortality rate among pregnant patients infected with hepatitis E, which sometimes accompanies hepatitis C. There have been no studies on pregnant women taking interferon.

..HOW DOES HCV AFFECT CHILDREN?

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Children with chronic hepatitis can not be treated simply like miniature adults. Specific issues and questions need to be addressed when dealing with the pediatric age group. Pediatric patients are less likely than adults to have symptoms of infection with hepatitis C, leaving the viruses undetected and possibly unknowingly spread. According to information available on the natural history of HCV, children have a higher rate of spontaneous viral clearance than adults, and generally a slower progression rate during the first 20 years of infection.

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Children who are chronic carriers of HCV have normal growth patterns. In 16 HCV children followed for up to 14years, encephalopathy (mental confusion), ascites (swollen stomach), or bleeding did not develop. The lack of cirrhosis in children with HCV is consistent with the fact that a time period of 10 to 20 years or more is required for cirrhosis to occur.

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Hepatocellular carcinoma occurs very rarely in the pediatric group. A recent study (2005) conducted by HELIOS Children's Hospital Wuppertal in Germany demonstrated that treatment with peginterferon-alfa-2b and ribavirin is a well tolerated and effective therapy for children with HCV genotype 2 or 3. The level of sustained viral response among patients varied,dependent upon the HCV genotype, liver enzyme levels, and the mode of infection. While receiving the therapy, 64 percent of patients had no detectable level of HCV RNA, and only five percent of patients relapsed during the follow-up period.

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The study also demonstrated the following:

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• All children infected with genotype 2 or 3 achieved a sustained viral response; however, less than half of patients infected with genotype1 had similar success

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• Children infected by their mothers did not respond as well as non-vertically infected children

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• Patients with normal liver enzyme levels before treatment responded better that thosewith above normal levels.

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(Hepatology Volume 41, Issue 5, Date: May2005, Pages: 1013-1018 Peginterferon alfa-2bplus ribavirin treatment in children and adolescents with chronic hepatitis C,)

..Children have surprisingly few side effects from treatment, compared to adults..RECOMMENDATIONS

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1. Diagnosis, testing, and liver biopsy of children thought to have HCV.

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2. Because of the high spontaneous clearance rate during the first year of life, testing for children of HCV-infected mothers is recommended at 18 months or later.

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3. Otherwise healthy children aged 3-17 may receive therapy with interferon alfa-2b and ribavirin, administered by specialists intreating children

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4. Children under the age of 3 should not be treated.

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(Doris B. Strader, DB, et al, HEPATOLOGY,April 2004 AASLD PRACTICE GUIDELINE,Diagnosis, Management

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The Newest Studies March 2010

Treating Childen With Hepatitis C Treatment of Hepatitis C in childrenPaloma Jara; Loreto HierroAuthors and DisclosuresPosted: 03/02/2010; Expert Rev Gastroenterol Hepatol. 2010;4(1):51-61. © 2010 Expert Reviews Ltd.

;. ..AbstractHepatitis C affects 4–10% of children born to infected mothers, and 80% of them develop chronic infection. Most patients with chronic hepatitis C virus infection are asymptomatic, with persistent or intermittent biochemical abnormalities.

,.Severe liver disease may develop 10 years after onset of infection, with a less than 2% overall risk during the pediatric age. Available therapies have no contraindication in children if otherwise healthy. The US FDA and EMEA have recently approved combined pegylated-IFN-α2b plus ribavirin treatment for children, who should be over 3 years of age in order to avoid severe side effects. Experiences in pilot trials and international studies indicate a response rate of 50% in genotype 1 patients, and more than 90% in genotype 2 or 3 patients, indicating resolution of chronic disease.,IntroductionThe possibility of curing chronic hepatitis C virus (HCV) infection by means of PEG-IFN plus ribavirin – the currently recommended treatment – has raised controversy about the convenience

of treating pediatric patients. As children with chronic HCV infection are usually asymptomatic and rarely develop severe liver damage, the possibility of eliciting adverse effects from current therapies must be appropriately balanced against the benefits. Characteristics of HCV infection in children and the results of treatment are reviewed here in order to substantiate decisions.The discovery of HCV and the use of anti-HCV levels as a marker of exposure was available in the early 1990s to exclude infected blood and organ donors. Before this, most HCV infections were acquired by transfusions or inadequately sterilized needles or instruments. Pediatric populations heavily affected in the past due to repeated administration of blood derivatives for hemoglobinopathies, hemophilia or cancer treatment are now young adults, and therefore beyond the scope of this revision. In certain areas of the world, post-transfusional hepatitis C remains a hazard.

Cumulative information on superimposed HCV infection to some underlying diseases of children indicates similar chronicization rates, deleterious effects of iron overload added to viral-induced liver damage and evidence of difficult-to-treat patients because of conditions that affect the tolerability of drugs, such as anemia or renal insufficiency.The effectiveness of excluding parenteral routes of HCV is demonstrated in young populations of industrialized countries.[1] Perinatal mother-to-child transmission accounts for 95% of all cases of hepatitis C in children born after 1990. In addition, over the years there has been a reduction in the number of pediatric cases of vertical transmission because the anti-HCV-positive rate has decreased in younger women as a result of lesser transfusional transmission of the disease, and due to changes in illicit drug abuse with a shift towards nonintravenous forms of administration.[2]In the current

setting, most affected children are otherwise healthy. The applicability of treatment is the rule. Combined treatment offers a 50–90% chance (according to HCV genotype) of clearing HCV infection, thus avoiding the progression of liver disease. This review will focus on the benefits of current therapy, mostly evident in the long term, and also on drug toxicity.

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Origin of HCV Infection in Children: Mother-to-child TransmissionCourse of HCV Infection in ChildrenLiver Damage in Pediatric Chronic HCV InfectionSevere Liver Disease in ChildrenOutcomes in Adult AgeTreatmentConclusionExpert

CommentaryFive-year View

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From PKIDS;

The Latest Treatment Options for Children with Hepatitis C.

Doctors who treat children infected with the hepatitis C virus (HCV) are essentially starting from scratch. There are only a handful of drugs available to treat this infection, and they have not been extensively studied in children. 2007

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Parent Story: Adjusting to Hepatitis C in Your Child.

How one family learned to use standard precautions when a child was found to be infected with hepatitis C. 2001

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Nationwide Directory of Advocacy Organizations.

This is a state-by-state directory of disability rights organizations available to parents whose children have infectious diseases. 2005

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Links & Resources

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PKIDS

k.Hepatitis C in ChildrenChronic hepatitis C infection in children is rare in the UK. However little we know about hepatitis C in adults, we know even less about hepatitis C in children. The good news is that there is increasing research into this area to understand HCV infection in children.Pediatric Liver Transplantation

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Pediatric SuperSite

..http://kidshealth.org/parent/infections/bacterial_viral/hepatitis.html

http://Hepatitis Cnewdrugs.blogspot.com/2010/05/children-with-hepatitis-c.html