European Paediatric Hepatitis C Virus Network. When does mother to child transmission of hepatitis C virus occur?

Paediatric HIV Service, Royal Hospital for Sick Children, Edinburgh, Scotland, UK.
Archives of Disease in Childhood - Fetal and Neonatal Edition (Impact Factor: 3.12). 04/2005; 90(2):F156-60. DOI: 10.1136/adc.2004.059436
Source: PubMed


To investigate when hepatitis C virus (HCV) infection from mother to child occurs, and evaluate possible associated factors.
Prospective cohort study.
Fifty four HCV infected children tested within three days of birth and their mothers.
HCV RNA polymerase chain reaction (PCR) results.
Seventeen of the children (31%, 95% confidence interval 19% to 46%) were positive in the first 3 days of life and could be assumed to have acquired infection in utero. Testing PCR positive was not associated with sex (53% v 49% boys; p=0.77) or mode of delivery (29% elective caesarean section in both groups; p=0.98). Children with evidence of intrauterine infection were significantly more likely to be of lower birth weight and infected with genotype 1 (58% v 12%, p=0.01). Although a higher proportion of infants born to HCV/HIV co-infected women were PCR positive in the first 3 days of life, this difference did not reach statistical significance; excluding infants born to co-infected women did not affect the results. Thirty seven of the children (68%) were negative in the first 3 days of life, 27 of whom were positive when tested again at 3 months, and nine were first PCR positive after 3 months (one child had no further tests).
These results suggest that at least one third and up to a half of infected children acquired infection in utero. Although postpartum transmission cannot be excluded, these data suggest that it is rare. The role of HCV genotypes in the timing and mechanism of infection should be explored further.


Available from: Marie-Louise Newell, Jan 09, 2014
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    • "Currently, there is no effective way to prevent the transmission of HCV from mother to infant. It is not certain when during pregnancy and delivery HCV transmission occurs, however, one study suggested that 1/3 to 1/2 of infants acquiring HCV from their mothers were infected in utero.75 Although HCV RNA is detectable in maternal colostrum, viral transmission via breastfeeding has not been well documented. "
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    ABSTRACT: Since 1992, the maternal-fetal route of transmission has become the dominant route for acquisition of hepatitis C (HCV) infection by children. With increasing knowledge of antiviral treatment for HCV infection, the main goal of therapy is to achieve a sustained virological response (SVR) as defined by undetectable serum HCV RNA by polymerase chain reaction assay six months after cessation of therapy. In young children, interferon therapy is more effective than in adults with chronic HCV infection (CHC). Although children clearly have a milder degree of liver pathology, data have indicated that hepatic inflammation from HCV infection can progress to fibrosis or cirrhosis in children. Hepatocellular carcinoma has been reported in adolescents with CHC. In this article, recent improvements in therapy of children with CHC and in the clinical development of new emerging drugs with potential use in children will be reviewed.
    Therapeutics and Clinical Risk Management 07/2009; 5(3):651-60. DOI:10.2147/TCRM.S5078 · 1.47 Impact Factor
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    • "Maternal viremia represents the most important risk factor [15] even though the possible transmission from HCV-RNA negative mothers has been also reported in the literature [16] [17]. This might be attributed to the typical trend of chronic infections that may alternate blood clearance phases to viremic phases. "
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    ABSTRACT: Study reports of mother to child transmission of hepatitis C virus (HCV) have shown transmission rates ranging from 3 to 37%, according to maternal viremia and HIV-1 coinfection. The present study evaluated the prevalence of the HCV infection in the general population and the incidence of vertical transmission, from women who delivered in the Obstetric Clinic of the Hospital of Parma from January 1st 1996 to 31st 2001 December. Mothers and children were tested for the presence of HCV-RNA within one week after delivery. Children were considered to be infected when they were found positive at least twice for viral RNA or antibodies were still detectable at the end of the follow-up period (18 months) in blood. Out of 13,025 women, 110 (0.8%) were found positive for anti-HCV antibodies; 72 of them (65.4%) were HCV-RNA positive. All 110 children were positive for anti-HCV antibodies in the first blood sample (time 0); 8 of them were HCV-RNA positive. Three children were still viremic at the end of the follow-up whereas 5 showed a clearance. No significant differences were found between viremic and nonviremic children with respect to gestational week, maternal alanine aminotransferase (ALT) levels and newborns weight at birth. This investigation shows that vertical transmission may occur in a general obstetric population despite a low prevalence of HCV-positive subjects.
    Journal of preventive medicine and hygiene 07/2007; 48(2):47-9.
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    • "occur whereas postpartum transmission is rare (Mok et al., 2005). Individual case reports exist showing different outcomes of vertical transmission of HCV in twin pregnancies (Barlow and Mok, 1993; Goncales et al., 2000; Inui et al., 2002). "
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    ABSTRACT: Mother to infant transmission of hepatitis C virus (HCV) is dependent on significant HCV viraemia being present in the mother. As yet there are no appropriate interventions to prevent perinatal transmission. The investigation of twin pregnancies where only one twin is infected may reveal further information relating to transmission and specific risks. Evaluation of these risks could affect decisions about the management of the deliveries of these mothers while more appropriate interventions are evaluated. The laboratory database was searched for all twins referred for testing at the Children's Hospital Liver Unit. The mothers and health care providers were contacted to gain more information about the pregnancies and deliveries of all of the twins. Four sets of twins had been investigated for HCV. In all cases only one twin had been infected. In three out of four cases the second twin had become infected. All of the twins were girls and the larger twin in each pair became infected. Premature rupture of membranes was associated with transmission in the only case in which the first-born became infected. There was no invasive foetal monitoring or episiotomy in any of the deliveries Transmission of HCV is more likely to affect the second twin, perhaps because placental separation during the delivery of the second twin exposes the infant to infection. Until effective interventions such as vaccination of newborns or antiviral treatment of mothers are evaluated, elective caesarean section could be recommended for HCV twin pregnancies in order to avoid premature membrane rupture and infection of the second twin.
    Journal of Clinical Virology 03/2007; 38(2):91-5. DOI:10.1016/j.jcv.2006.11.012 · 3.02 Impact Factor
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