Hepatitis C in Children

Hepatitis C in children is uncommon. However, there are still 11 million children infected in the world. To put that number into perspective, it is equal to the entire population of Cuba. Children with hepatitis C have their care managed slightly differently from care for adults.¹

Prevalence in the US

In the United States, antibodies to the hepatitis C virus are found in 0.3%, or 3 in 1000, children younger than 14 years of age. It is estimated that out of those children who have antibodies to the virus, 75%-80% of them are also RNA-positive. This means that they have an active hepatitis C infection.²

In children above 14 years of age, 9% have HCV antibodies.² This number is increasing, particularly in the suburbs, and is attributed to the opioid crisis.

Prevalence in other countries

In contrast, it is estimated that 0.15% of children between 1 to 19 years of age have hepatitis C globally. Most of these kids live across the Middle East, Africa, and Asia.³

Transmission in children

The most common source of transmission in developed countries is perinatal, or during birth. When hepatitis C is passed from a mother to a baby in the womb, it is also referred to as vertical transmission. However, not all mothers infected with hepatitis C pass on the infection. Only 1%-5% of mothers will do so. The risk is higher in mothers who have a high viral load during delivery. Because of this, it is important if you are pregnant that you get treated prior to delivery to reduce the viral load.⁴

In adolescents, infection is more commonly a result of contaminated tattoo equipment or sharing of needles.

Spontaneous clearance

Babies who are infected with hepatitis C perinatally are more likely to clear the virus on their own compared to adults. In fact, 20%-45% of babies spontaneously clear the virus. Of those who continue to be infected, a small proportion of them will progress to advanced fibrosis. Cirrhosis is even more uncommon in this population. In one study of 332 children with active hepatitis C, 6 adolescents progressed to decompensated cirrhosis.^{5, 6}

Treatment of hep C in children

While there are many agents that can be used to treat hepatitis C in adults, there is a lack of evidence supporting some of these treatments in children. Some manufacturers only test their products on adults. Treatment of hepatitis C in children depends on the age group:

• Children less than 3 years of age: Treatment in this age group is deferred because children will often resolve the infection on their own. In addition, many direct-acting antivirals cannot be used in young children.
• Children between the ages of 3 and 6: Treatment may be initiated in these children. Harvoni (Ledipasvir-sofosbuvir) has been approved for kids 3 years of age and older and is the primary agent of choice for children with genotypes 1, 4, 5, or 6.
• Children 6 years old and older:Epclusa, or sofosbuvir-velpatasvir, is the most common combination used in kids; the dose depends on the child’s weight.

The most important aspect of managing children with hepatitis C is informing their families and teachers that the virus is not spread at school from close contact. This is vital so children do not feel isolated as a result of their condition.