PUBLIC HEALTH
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Do not postpone referral to HCV provider. Treatment may be
available, even while continuing to use drugs, and may help to
reduce spread of HCV to others.
PREGNANCY AND HCV INFECTION
Approximately six of every 100 infants born to HCV-infected moth-
ers become infected with the virus. Transmission occurs at the time
of birth, and no prophylaxis is available. The risk is increased by
the presence of maternal HCV viremia at delivery and is two to
three times greater if the woman is co-infected with HIV. Most
infants infected with HCV at birth have no symptoms and do well
during childhood. More research is needed to find out the long-
term effects of perinatal HCV infection (20). At this time, CDC is
in the process of reviewing the evidence to determine if additional
HCV screening recommendations, specific to pregnant women,
are warranted (17, 20-21).
In April 2018, the Kentucky legislature amended SB 250 KRS
214.160 to establish that all pregnant women be tested for hepatitis
C and recommend testing for children born from a pregnant woman
who has a positive hepatitis C result. HCV infection in pregnant
women and infants born to mothers with hepatitis C is reportable
to public health officials. Complete the EPID 394 Kentucky Report-
able Disease Form https://bit.ly/2xzzCUy and fax to 502-574-5865
in Jefferson County, Kentucky or 502-564-4760 in other Kentucky
counties (13).
There is no evidence that breastfeeding spreads HCV. However,
HCV-positive mothers should consider abstaining from breastfeed-
ing if their nipples are cracked or bleeding (22).
INFANTS BORN TO MOTHERS WITH HCV INFECTION
On April 2018, the state legislature also amended SB 250 KRS
214.160 to recommend testing for children born from a pregnant
woman who has a positive hepatitis C test result (13). The KDPH
recommends HCV RNA testing for infants born to mothers infected
with HCV at the infant’s well-child visit at age two months or four
months. HCV RNA testing should then be repeated at a subsequent
visit in four to six months, independent of the initial HCV RNA test
result if the first test is reported as negative (23).
An infant born to mothers with HCV infection is reportable to
public health officials in Kentucky. Complete the EPID 394 Form
listed above and fax to the appropriate number. An alternative anti-
HCV antibody test (anti-HCV) can be offered no sooner than age
18 months because anti-HCV from the mother might last until this
age (23). Refer children with positive HCV test results to identified
HCV pediatric specialists in your region.
References
1. Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology.
1997;26(3 Suppl 1):15S-20S.
2. Marcellin P. Hepatitis C: the clinical spectrum of the disease. J Hepatol.
1999;31(Suppl 1):9-16.
3. Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet.
2008;372(9635):321-32.
4. Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history,
treatment, and prevention of hepatitis C. Ann Intern Med. 2000;132(4):296-305.
5. Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis.
2005;9(3):383-98.
6. National Institute of Diabetes and Digestive and Kidney Diseases. Definition
and facts of liver transplant. Available at: https://www.niddk.nih.gov/health-in-
formation/liver-disease/liver-transplant/definition-facts.
7. Center for Disease Control and Prevention. Viral hepatitis statistics and sur-
veillance. Retrieved from: https://www.cdc.gov/hepatitis/statistics/index.htm
8.
Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—
United States, 2016. Atlanta: US Department of Health and Human Services,
Centers for Disease Control and Prevention; 2018. Retrieved from https://
www.cdc.gov/hepatitis/statistics/2016surveillance/index.htm.
9. Centers for Disease Control and Prevention. . Increases in Hepatitis C Vi-
rus Infection Related to Injection Drug Use among Persons Aged ≤30 Years
— Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. MMWR
2015;64(17);453-458. Retrieved from http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm6417a2.htm?s_cid=mm6417a2_w
10. Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, Stone
J, Cunningham EB, Trickey A, Dumchev K, Lynskey M, Griffiths P, Mattick
RP, Hickman M, Larney S. Global prevalence of injecting drug use and so-
ciodemographic characteristics and prevalence of HIV, HBV, and HCV in
people who inject drugs: a multistage systematic review. Lancet Global Health.
2017;5(12):e1192-1207.
11. Centers for Disease Control and Prevention. Recommendations for the Iden-
tification of Chronic Hepatitis C Virus Infection Among Persons Born During
1945-1965. MMWR Recomm Rep. 2012;61(RR04);1-18. Retrieved from http://
www.cdc.gov/hepatitis/populations/1945-1965.htm
12. Egro FM, Nwaiwu CA, Smith S, Harper JD, Spiess AM. Seroconversion rates
among health care workers exposed to hepatitis C virus-contaminated body
fluids: the University of Pittsburgh 13-year experience. Am J Infect Control.
2017;45(9):1001-5.
13. Kentucky Department of Public Health. 2018 HCV Testing Guidance Re-
trieved from: https://chfs.ky.gov/agencies/dph/dpqi/hcab/Documents/2018%20
FINAL%20HCV%20LHD%20Testing%20Guidance%20%28003%29.pdf
14. Orland JR, Wright TL, Cooper S. Acute hepatitis C. Hepatology. 2001;33(2):321–
7.
15. Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, Hu
PY, Miller JK, Gerber MA, Sampliner RE, et al. The natural history of commu-
nity-acquired hepatitis C in the United States. The Sentinel Counties Chronic
non-A, non-B Hepatitis Study Team. N Engl J Med. 1992;327(27):1899-1905.
16. Farci P, Alter HJ, Wong D, Miller RH, Shih JW, Jett B, Purcell RH. A long-term
study of hepatitis C virus replication in non-A, non-B hepatitis. N Engl J Med.
1991;325(2):98-104.
17. Barrera JM, Bruguera M, Ercilla MG, Gil C, Celis R, Gil MP, del Valle Onorato
M, Rodes J, Ordinas A. Persistent hepatitis C viremia after acute self-limiting
posttransfusion hepatitis C. Hepatology. 1995;21(3): 639-44.
18. American Association for the Study of Liver Diseases (AASLD) and the In-
fectious Diseases Society of America (IDSA). Recommendations for testing,
management, and treating hepatitis C. HCV testing and linkage to care.
Available at: https://www.hcvguidelines.org.
19. Center for Disease Control and Prevention. Hepatitis C Questions and Answers
for Health Professionals, Counseling Patients. Retrieved from: https://www.
cdc.gov/hepatitis/hcv/hcvfaq.htm#section5
20. Roberts EA, Yeung L. Maternal-infant transmission of hepatitis C virus infec-
tion. Hepatology. 2002;36(5 Suppl 1):S106-13.
21. Centers for Disease Control and Prevention. Recommendations for prevention
and control of hepatitis C virus (HCV) infection and HCV-related chronic
disease. MMWR Recomm Rep. 1998;47(No. RR-19):1-39.
22. Moyer VA, US Preventive Services Task Force. Screening for hepatitis C virus
infection in adults: U.S. Preventive Services Task Force Recommendation
Statement. Ann Intern Med. 2013;159(5):349-57.
23. Cottrell EB, Chou R, Wasson N, Rahman B, Guise JM. Reducing risk for
mother-to-infant transmission of hepatitis C virus: a systematic review for
the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(2):109-13.
24. Mast EE, Hwang LY, Seto DS, Nolte FS, Nainan OV, Wurtzel H, Alter MJ. Risk
factors for perinatal transmission of hepatitis C virus (HCV) and the natural
history of HCV infection acquired in infancy. J Infect Dis. 2005;192(11):1880-9.
Additional Resources:
Additional CDC guidance on viral hepatitis surveillance and case management
(https://www.cdc.gov/hepatitis/statistics/surveillanceguidelines.htm)is available at
https://www.cdc.gov/hepatitis/statistics/surveillanceguidelines.htm and case report
form can be found at https://www.cdc.gov/hepatitis/pdfs/HepatitisCaseRprtForm.pdf
HCV Post-Exposure Guidelines: https://www.cdc.gov/mmwr/preview/mmwrhtml/
rr5011a1.htm
UCSF Post Exposure Prophylaxis Hotline and resources: http://nccc.ucsf.edu/
clinician-consultation/pep-post-exposure-prophylaxis/
Hep B / C coinfected patient management guidelines:
http://hcvguidelines.org/ and https://www.aasld.org/publications/practice-guide-
lines-0.
Dr. Lori Caloia is the medical director of the Louisville Metro Department
of Public Health and Wellness.
OCTOBER 2018
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