Division of Pediatric Infectious Diseases, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
J Pediatric Infect Dis Soc. 2024 Nov 21;13(Supplement_5):S153-S158. doi: 10.1093/jpids/piae078.
In the United States, the burden of hepatitis C virus (HCV) infection is disproportionately high among young adults including pregnant persons, resulting in increased infections among children as perinatal transmission remains the main route of HCV infection in children. Hence, in 2020, the Centers for Disease Control and Prevention (CDC) recommended universal HCV screening during each pregnancy. HCV infection in infancy is usually asymptomatic, so the diagnosis entirely relies on testing of perinatally exposed infants which, historically, included anti-HCV antibody testing at ≥18 months of age. However, nation-wide perinatal HCV testing rates have been suboptimal with significant loss to follow-up. To address this problem, in 2023, the CDC introduced early single HCV RNA testing at 2-6 months of age with an alternative for HCV RNA testing up to 17 months of age if not previously tested. The high sensitivity and specificity of the HCV real-time PCR laid the grounds for this policy shift. In this review, we highlight how these new CDC recommendations will enhance testing of infants and children and ultimately contribute to overall HCV elimination efforts. We also emphasize the role of all pediatric providers and obstetricians in implementing these new guidelines. Additionally, we offer our perspective and practical advice for testing of perinatally exposed infants and children. Currently, curative oral antivirals for HCV-infection treatment are approved for children ≥3 years of age. As pediatricians, advocating for children's wellness, it is our utmost duty to ensure that every child exposed to perinatal hepatitis C has been tested, diagnosed, linked to care, treated, and achieved cure.
在美国，丙型肝炎病毒（HCV）感染的负担在包括孕妇在内的年轻成年人中不成比例地高，导致儿童中的感染增加，因为围产期传播仍然是儿童 HCV 感染的主要途径。因此，2020 年，疾病控制与预防中心（CDC）建议在每次妊娠期间进行普遍的 HCV 筛查。婴儿期 HCV 感染通常无症状，因此诊断完全依赖于对围产期暴露婴儿的检测，从历史上看，这包括在≥18 个月龄时进行抗-HCV 抗体检测。然而，全国范围内围产期 HCV 检测率一直不理想，存在大量失访。为了解决这个问题，2023 年，CDC 推出了在 2-6 个月龄时进行单次 HCV RNA 检测的方案，如果之前未检测过，可选择在 17 个月龄之前进行 HCV RNA 检测。HCV 实时 PCR 的高灵敏度和特异性为这一政策转变奠定了基础。在这篇综述中，我们强调了这些新的 CDC 建议将如何增强对婴儿和儿童的检测，并最终为 HCV 消除工作做出贡献。我们还强调了所有儿科医生和产科医生在实施这些新指南方面的作用。此外，我们还提供了我们对围产期暴露婴儿和儿童检测的看法和实用建议。目前，治疗 HCV 感染的口服抗病毒药物已批准用于≥3 岁的儿童。作为儿科医生，倡导儿童健康，我们的首要职责是确保每一个接触围产期丙型肝炎的儿童都接受了检测、诊断、与护理机构建立联系、得到治疗并实现治愈。
