Hepatitis C Virus Infection in Children

What is hepatitis C?

Inflammation of the liver is known as "hepatitis". There are many causes of hepatitis, and usually in children it is caused by a viral infection. Hepatitis C is one of the viruses that can cause hepatitis, along with other viruses such as hepatitis A or B.

Six strains (or types) of HCV have been identified. These are called "genotypes". HCV genotypes 1 and 3 are the commonest types found in Australia.

There is no immunisation currently available against hepatitis C.

Symptoms

Hepatitis C virus infection may cause no obvious symptoms, even though liver damage may be occurring. After 10 to 15 or more years of infection it can cause chronic liver disease; this may present with jaundice (yellowing of the whites of the eyes and the skin), tiredness, nausea, fever and lack of appetite.

Who gets hepatitis C virus?

The hepatitis C virus is spread by blood and body fluids. People at particular risk are intravenous drug users who share needles, and people who received blood transfusions before February 1990, when screening of blood for Hepatitis C began in Australia. Hepatitis C can be spread sexually although this is uncommon.

Can babies catch hepatitis C from their mothers?

Yes, transmission of the virus can occur from a mother to her baby.

This is known as vertical transmission. It is thought to occur whilst in-utero or during delivery; caesarean section does not reduce the risk of transmission. Of 100 babies born to mothers who have Hepatitis C, approximately 5-7 of those babies (5-7%) will acquire the virus.

Hepatitis C virus has not been shown to be transmitted through breast milk and breastfeeding is encouraged. If the mother has cracked and bleeding nipples the milk should be pumped and discarded until nipples have healed.

What are the long term effects?

Children with chronic hepatitis C virus infection usually feel perfectly well. After many years of infection they may develop cirrhosis of the liver (increasing and permanent scarring of the liver) or liver cancer, but this is unusual in childhood. Chronic hepatitis C infection with subsequent liver disease and/or hepatocellular cancer is one of the commonest indications for liver transplantation in adults; this is rarely required in children.

It is difficult to predict who will go on to develop serious liver problems and therefore it is important for all children infected with HCV to be monitored.

It is important to maintain a healthy liver by immunising against other hepatitis viruses like hepatitis B and hepatitis A. In addition, a good diet to minimise risks of being overweight, regular exercise and avoiding alcohol in adult life are other recommended measures.

Can hepatitis C be treated?

Yes, many adults are treated with Pegylated Interferon and Ribavirin.

The length of treatment depends on the strain (genotype) of HCV that you are infected with ranging between 6 and 12 months.

In some cases children are treated for HCV. This will be discussed in detail with you and your specialist and may depend on how your child's liver is functioning, the impact of symptoms on child's life, blood results, liver biopsy and ultrasound results.

Can hepatitis C virus be caught?

Q From other children playing together or in the classroom?
A No.

Q From a blood transfusion nowadays?
A There is a very low risk in Australia, but infection can occur if a recently infected blood donor's hepatitis C test is not yet positive.

Who should be tested for hepatitis C virus?

• Children born to HCV infected mother.
• Anyone who has symptoms of hepatitis or anyone with unexplained abnormal liver tests.
• Anyone at risk of hepatitis C due to exposure to blood or blood products before February 1990.
• Intravenous drug users who have shared needles.

• HCV is spread by contact with infected blood
• It is important to know your hepatitis C status if you are at risk of hepatitis C