[Fwd: PRO> Hepatitis C virus, perinatal transmission risk - UK]
From: Jim Connerth (babydoc@apex.net)
Mon Sep 18 21:36:46 2000
ProMED-mail wrote:
> HEPATITIS C VIRUS, PERINATAL TRANSMISSION RISK - UK
> ***************************************************
> A ProMED-mail post
> <http://www.promedmail.org>
>
> [see also:
> Hepatitis C virus, risk assessment 20000726.1243]
>
> Date: Sun, 17 Sep 2000 15:35:12 -0400
> From: Marjorie P. Pollack <pollackmp@mindspring.com>
> Source: Eurosurveillance Weekly, Issue 37, 14 Sep 2000 [edited]
> <http://www.eurosurv.org/update/>
>
> Mother to child transmission of hepatitis C virus during labour
> ---------------------------------------------------------------
> The overall risk of vertical transmission of hepatitis C virus (HCV) in the
> ---------------------------------------------------------------
> United Kingdom (UK) and Ireland is 6.7%, according to a cohort study
> ---------------------------------------------------------------
> reported in the Lancet last week. The risk is higher for children of
> mothers co-infected with HIV (odds ratio 3.8) and for children delivered
> vaginally or by emergency caesarean section than by elective caesarean
> section, but breast feeding appears not to affect the transmission rate.
>
> The study used data from 441 pairs of HCV infected mothers and their
> children - 214 in the Republic of Ireland (collected from January 1994 to
> April 1999) and 227 from the UK (collected from March 1997 to April 1999).
> The timing of antibody tests and uncertainty about the sensitivity of HCV
> RNA polymerase chain reaction (PCR) made definitive diagnosis or exclusion
> of HCV infection impossible for most children. The probability of infection
> for each child was estimated from the rate of loss of antibody to HCV and
> the sensitivity and specificity of HCV RNA PCR. Seventy-eight per cent of
> women (343) were reported to have acquired HCV through injecting drug use,
> 7% (33) through infected blood or blood products, and 15% (65) through
> other or unknown routes. Their average age was 27 years; 28 were non-white;
> and 22 were known to be co-infected with HIV (HIV status was unknown for
> 91). 135 of the 144 children who became anti-HCV negative had no
> virological evidence of infection. 248 of the remaining 297 children had at
> least one RNA PCR test: this was positive in 6 of the 156 children tested
> once, a further 8 were consistently positive, 71 were consistently
> negative, and 13 had discordant results. An estimated 50% of uninfected
> children became seronegative by 8 months of age, with only 5% having
> detectable anti-HCV at 13 months.
>
> The authors conclude that testing neonates is of little value, since the
> sensitivity of HCV RNA PCR was only 22% in the first month of life but rose
> swiftly then to reach 97%. They suggest that a negative RNA PCR test after
> 1 month of age almost certainly rules out infection, but say that a
> positive PCR test leads to a revised risk of 73% and should prompt further
> testing. They recommend delaying confirmatory serological testing until 12
> to 15 months to avoid detecting maternal antibody. They call for further
> studies to assess the apparent protective effect of elective caesarean
> section.
>
> [Byline: Stuart Handysides <shandysi@phls.org.uk>, Public Health Laboratory
> Service Communicable Disease Surveillance Centre, London, England].
>
> --
> ProMED-mail
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> [The reference for the Lancet paper is the following: Gibb DM, Goodall RL,
> Dunn DT, Healy M, Neave P, Cafferkey M, et al. Mother-to-child transmission
> of hepatitis C virus: evidence for preventable peripartum transmission.
> Lancet 2000; 356: 904-7 (<http://www.thelancet.com>). - Mod.CP]
> ............................cp/es
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