Women of childbearing age show increased risk for HCV

Women of childbearing age in Kentucky and nationally had increased rates of hepatitis C virus detection between 2011 and 2014, according to new data published in MMWR. The rate of children born to mothers with the infection also increased, indicating potential increased risk for mother-to-child transmission.

“All pregnant women should be assessed for hepatitis C risk factors and those at risk should be tested,” Alaya Koneru, MPH, epidemiologist at the CDC, told Infectious Disease News. “The fact that these data show both an increase in hepatitis C among women of childbearing age and an increase in infants born to women diagnosed with hepatitis C indicates that a new generation may be a risk for this serious but preventable disease.”

Koneru and colleagues based their study on the fact that reporting of all cases of HCV is not mandated in all states.

“A substantial proportion of HCV-infected women of childbearing age, including pregnant women, are likely not reported in routine state-based surveillance systems,” they wrote.

To determine trends in HCV detection in women of childbearing age and HCV testing among children aged 2 years and younger, Koneru and colleagues collected and analyzed data — nationally and specifically for Kentucky — between 2011 and 2014 using commercial laboratory data from Quest Diagnostics. Trends in proportions of infants born to HCV-infected mothers also were assessed using birth certificate data from the National Center for Health Statistics.

During the study period, the national rate of HCV detection among women of childbearing age increased from 139 per 100,000 population to 169 per 100,000 women (22%). The national rate of HCV testing among children aged 2 years and younger grew from 310 per 100,000 to 353 per 100,000 children (14%). Also, the number of infants born to mothers with HCV increased 68% nationally from one in 536 (0.19%) to one in 308 (0.32%).

The rate of HCV detection among women of childbearing age in Kentucky rose from 275 per 100,000 women to 862 per 100,000 women (213%), and the rate of HCV testing among children aged no older than 2 years increased 151%, from 403 per 100,000 to 1,011 per 100,000 children. Kentucky had the highest incidence of acute HCV for any state during the study period, the report said. Further, the number of infants born to mothers with HCV in Kentucky increased from one in 142 (0.71%) to one in 63 (1.59%), a 124% increase.

“About 6% of infants born to mothers living with hepatitis C are infected with the virus during pregnancy or childbirth, though the likelihood increases if a woman has a high viral count or is coinfected with HIV,” Koneru said.

HCV surveillance in Kentucky between 2011 and 2014 identified 777 pregnant women who were positive for HCV antibody, including 68% who were aged 20 to 29 years and 28% aged 30 to 39 years.

“These findings highlight the importance of following current CDC recommendations to identify, counsel, and test persons at risk for HCV infection including pregnant women, as well as consider developing public health policies for routine HCV testing of pregnant women, and expanding current policies for testing and monitoring children born to HCV-infected women,” the researchers wrote.

Koneru said there are challenges for this patient population, as current treatment options are limited.

“It is not yet clear whether recent advances in hepatitis C treatment are safe for pregnant women and their babies,” she said. “More research is urgently needed.

“Every woman at risk for hepatitis C should be tested, and if diagnosed, they should work with their health care providers to be linked to care and treatment.” – by Melinda Stevens

Disclosure: Koneru reports no relevant financial disclosures.