Hepatitis C Screening for At-Risk Newborns

Source: DiNicola J, Lentscher A, Liu H, et al. Pediatric hepatitis C screening by maternal hepatitis C infection status during pregnancy. J Pediatr Infect Dis Soc. 2024;13(9):445-454; doi: 10.1093/jpids/piae066.Investigators from the University of Pittsburgh School of Medicine, Pittsburgh, PA, conducted a retrospective study to assess differences in rates of infant hepatitis C virus (HCV) screening by maternal HCV infection status. Study participants were infants born to mothers with previous, probable, or active HCV infection at 1 institution between 2015 and 2019 and were identified using ICD-9 and ICD-10 codes for maternal HCV infection and infant testing. Only infants who received ≥2 well child visits at affiliated clinical sites were included. Maternal HCV infection status was based on viral load (VL). Those who were VL-positive were classified as having active infection, those who were VL-negative were categorized as having previous HCV infection, and those whose VL status was unknown were considered to have probable infection. The primary outcome was HCV testing in the infants born to mothers with a history of HCV infection. HCV testing was considered to have been ordered in an infant with prenatal HCV exposure if an HCV antibody test was ordered after the child was ≥6 months old, or if HCV nucleic acid testing (NAT) was ordered after the age of ≥2 months. Multivariate logistic regression was used to evaluate the association between infant HCV testing and maternal HCV infection status, after controlling for covariates. A main secondary outcome was infant HCV infection, defined as a positive HCV NAT obtained after the age of 2 months. Univariate analyses were used to test the association between infant HCV infection and maternal infection status.Data were analyzed on 503 infants with prenatal HCV exposure. Of these patients, 137 (27%) were born to mothers with previous HCV infection, 106 (21%) with probable HCV infection, and 260 (52%) with active HCV infection at the time of birth. HCV screening was ordered for 385 (77%) HCV-exposed infants. Compared to infants born to mothers with previous HCV infection, those born to mothers with active infection were significantly more likely to have screening tests ordered (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.5, 4.4). However, there was no significant difference in ordering of HCV screening among infants born to mothers with probable HCV infection and those born to mothers with previous infection (aOR, 1.6; 95% CI, 0.9, 3.2). Among those with HCV screening, 9 infants (3.4%) had HCV infection, based on HCV NAT. There was no statistical association in rates of transmission by maternal VL, but the analysis was limited by the small number of infants with positive HCV NAT.The authors conclude that many HCV-exposed infants were not adequately screened postnatally for HCV infection.Dr Beam has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.HCV infection has surged in recent decades, placing infants born to mothers with HCV at risk of contracting the virus. (See AAP Grand Rounds. 2019;41[4]:45.)1 Despite this, screening rates for infants exposed to HCV remain suboptimal. The authors of the current study found that many infants with a perinatal HCV exposure were not screened, with multiple factors contributing to these variable screening rates.Universal maternal screening was recommended in 2021 by the CDC and subsequently major obstetrics and gynecology organi-zations,2 yet the transition away from prior risk-based protocols has been gradual. A significant challenge in perinatal HCV screening lies in the division of responsibilities between maternal and newborn care providers. While electronic health records (EHRs) offer the potential for seamless communication of critical perinatal testing results, gaps remain.3 (These lapses can leave newborn providers unaware of key maternal and fetal conditions, including HCV infection, which are essential for infant care. Furthermore, information such as maternal HCV status and viral load may be buried deep within EHRs, requiring providers to undertake time-consuming searches for critical data. In 2023, the CDC updated its screening and testing guidelines recommending pediatric HCV screening based on maternal infection status.4Beyond improved communication between obstetric and pediatric care teams, additional barriers must be addressed to ensure appropriate screening and avoid unnecessary testing of low-risk infants. Although CDC guidelines have evolved,2 awareness of these updates among pediatric providers may lag. Previously, HCV testing for infants occurred at 18 months of age.5 With the shift to earlier screening, some infants may be missed during this new window, leading to loss of follow-up and delayed diagnosis. To mitigate this, it is crucial to incorporate updated guidelines into clinical care protocols and workflows.Postnatal Hepatitis C screening needs significant improvement, particularly for infants born to mothers with active or probable HCV infection. Streamlining communication between maternal and newborn care providers is vital to ensuring timely and appropriate follow-up.Pediatric HCV infection is a treatable disease, obviating the risk of chronic infection and its complications.4 Thus, the need to remediate impediments to screening and treating infected infants identified in the current study.