The CDC released new recommendations for hepatitis C virus (HCV) screening among perinatally exposed infants and children.

The four new recommendations detailed in the MMWR Recommendations and Reports are as follows:

• All perinatally exposed infants should be screened for HCV with a nucleic acid test (NAT) for detection of HCV RNA at ages 2 to 6 months
• All infants and kids with detectable HCV RNA should see a healthcare provider with expertise in pediatric hepatitis C management
• Exposed infants and kids with an undetectable HCV RNA result at or after 2 months of age do not need to seek further follow-up unless “clinically warranted”
• An NAT for HCV RNA is recommended for perinatally exposed infants and children ages 7 to 17 months who previously have not been tested, and an HCV antibody test followed by a reflex NAT for HCV RNA (when anti-HCV is reactive) is recommended for perinatally exposed kids ages 18 months and older who previously have not been tested

While rates of HCV have been rising among people of reproductive age and pregnant people, a systematic review of data from 12 studies showed that only 30.1% of perinatally exposed infants and children are tested for HCV infection, noted Lakshmi Panagiotakopoulos, MD, of the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, and colleagues.

HCV develops in 6% to 7% of perinatally exposed infants and children, and these children often remain undiagnosed, they wrote, adding that reasons for this might include “lack of awareness of perinatal exposure by pediatric providers, lack of regular pediatric care among exposed children, and changes in health care providers before the time of HCV testing (currently recommended at age 18 months).”

Testing perinatally exposed infants beginning at age 2 months “is cost-effective and allows for earlier linkage to care, appropriate evaluation, and the opportunity to provide curative, life-saving therapy,” they continued, noting that children generally attend well-child visits in the first 6 months of life than at 18 months or later.

Additionally, curative direct-acting antiviral therapy is approved by the FDA for people starting at age 3 years. Thus, “the benefits of testing were determined to outweigh any potential and identified harms,” Panagiotakopoulos and team stressed.

“The most common harms related to testing for perinatal HCV infection relate to interpretation of test results, including intermittent or transient viremia, false-positive antibody results, false-negative antibody results, the cost of testing, and stigma,” they wrote. “However, currently used NATs for HCV RNA tests are highly sensitive and specific for diagnosing perinatal HCV transmission.”

Ultimately, the CDC researchers advised that providers implement these latest recommendations for all infants and children born to pregnant persons with current or probable HCV infection.

Previous CDC recommendations, as of April 2020, were to screen all patients 18 and older for HCV at least once in their lifetime, while those with recognized exposures, such as injection drug use, should screen regardless of age. The only exceptions were people living in areas where the HCV RNA positivity rate was <0.1.

“Regardless of when a child is seen by a provider, opportunities exist for education, testing and evaluation, curative treatment, and progress toward the goal of hepatitis C elimination,” the authors concluded.

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