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When does mother to child transmission of hepatitis C virus occur?
  1. J Mok1,
  2. L Pembrey2,
  3. P-A Tovo3,
  4. M-L Newell2,
  5. for the European Paediatric Hepatitis C Virus Network
  1. 1Paediatric HIV Service, Royal Hospital for Sick Children, 10 Chalmers Crescent, Edinburgh EH9 1TS, Scotland, UK
  2. 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health & Great Ormond Street Hospital for Children NHS Trust, University College London, 30 Guilford Street, London WC1N 1EH, UK
  3. 3Dipartimento di Scienze Pediatriche e dell’Adolescenza, Università degli Studi di Torino, Piazza Polonia 94, 10126 Torino, Italy
  1. Correspondence to:
    Professor Newell
    Centre for Paediatric Epidemiology & Biostatistics, Institute of Child Health (University College London), 30 Guilford Street, London WC1N 1EH, UK; m.newellich.ucl.ac.uk

Abstract

Objective: To investigate when hepatitis C virus (HCV) infection from mother to child occurs, and evaluate possible associated factors.

Design: Prospective cohort study.

Patients: Fifty four HCV infected children tested within three days of birth and their mothers.

Main outcome measures: HCV RNA polymerase chain reaction (PCR) results.

Results: Seventeen of the children (31%, 95% confidence interval 19% to 46%) were positive in the first 3 days of life and could be assumed to have acquired infection in utero. Testing PCR positive was not associated with sex (53% v 49% boys; p  =  0.77) or mode of delivery (29% elective caesarean section in both groups; p  =  0.98). Children with evidence of intrauterine infection were significantly more likely to be of lower birth weight and infected with genotype 1 (58% v 12%, p  =  0.01). Although a higher proportion of infants born to HCV/HIV co-infected women were PCR positive in the first 3 days of life, this difference did not reach statistical significance; excluding infants born to co-infected women did not affect the results. Thirty seven of the children (68%) were negative in the first 3 days of life, 27 of whom were positive when tested again at 3 months, and nine were first PCR positive after 3 months (one child had no further tests).

Conclusions: These results suggest that at least one third and up to a half of infected children acquired infection in utero. Although postpartum transmission cannot be excluded, these data suggest that it is rare. The role of HCV genotypes in the timing and mechanism of infection should be explored further.

  • HCV, hepatitis C virus
  • PCR, polymerase chain reaction
  • hepatitis C virus
  • mother to child transmission
  • polymerase chain reaction
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Footnotes

  • The European Paediatric HCV Network is funded by a European Commission concerted action grant–Quality of Life and Management of Living Resources Programme, contract number: QLK2-CT-2001-01165. L P is funded by a UK Medical Research Council Special Research Training Fellowship in Health Services and Health of the Public Research.

  • Competing interests: none declared

  • Appropriate ethical approval was obtained from each centre.

    European Paediatric HCV Network collaborators: A Amoroso (Università di Trieste, Trieste, Italy), F Asensi-Botet, A Pereda (University Children’s Hospital La Fè, Valencia, Spain), V Balossini, G Bona, M Zaffaroni (Clinica Pediatrica, Università del Piemonte Orientale, Novara, Italy), A Bandelloni, A Coscia, C Fabris (Cattedra di Neonatologia, Università di Torino, Torino, Italy), C Belloni (Neonatology and Neonatal Intensive Care Unit, IRCCS Policlinico San Matteo, Pavia, Italy), G Bossi, B Salati (Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy), C Boucher (University Hospital Utrecht, Utrecht, The Netherlands), W Buffolano (Dipartimento di Pediatria, Università Federico II, Napoli, Italy), K Butler (Our Lady Hospital for Sick Children, Crumlin, Dublin, Ireland), L Cabero Roura, JM Bertran Sanges (Hospital Universitari Materno-Infantil, Barcelona, Spain), P Cigna (Centro di Neonatologia, Ospedale Infantile Regina Margherita, Torino, Italy), LM Ciria, C Servera Ginard (Hospital Son Dureta, Palma de Mallorca, Spain), G Claret Teruel, C Fortuny (Hospital Sant Joan de Déu, Barcelona, Spain), O Coll (Hospital Clinic, Barcelona, Spain), A Corrias, R Ledda, S Floris (Servizio di Puericultura, Cagliari, Italy), A De Maria (Dipartimento di Medicina Interna, Università di Genova, Genova, Italy), J Echeverria, G Cilla (Department of Paediatrics and Department of Microbiology, Hospital Donostia, San Sebastian, Spain), G Faldella, M Lanari, E Tridapalli, V Venturi, (Università di Bologna, Bologna, Italy), B Fischler, A-B Bohlin, S Lindgren, G Lindh (Huddinge Hospital, Huddinge, Sweden), V Giacomet, L Schneider, C Figini, L Caffarelli, A Viganò (Ospedale Sacco, Milano, Italy), S Hannam, G Mieli-Vergani (King’s College Hospital, London, UK), A Hatzakis (National Retrovirus Reference Centre, University of Athens, Athens, Greece), C Inchley, HO Fjaerli (Akershus University Hospital, Norway), A Maccabruni (Department of Infectious Diseases, Università di Pavia, Pavia, Italy), M Marcellini, MR Sartorelli (Ospedale Bambino Gesù, Roma, Italy), P Martin Fontelos (Servicio de Pediatria, Instituto de Salud Carlos III, Madrid, Spain), A Mazza (Ospedale Santa Chiara di Trento, Trento, Italy), JYQ Mok (Royal Hospital for Sick Children, Edinburgh), A Mûr, M Viñolas (Hospital del Mar, Universitat Autonoma de Barcelona, Spain), DM Paternoster, P Grella (Istituto di Ginecologia e Ostetricia, Padova, Italy), S Polywka (Institute for Medical Microbiology and Immunology, University Hospital Eppendorf, Hamburg, Germany), I Quinti, A M Casadei (Università La Sapienza, Roma, Italy), A Rojahn, A Berg (Ullevål University Hospital, Oslo, Norway), R Rosso, S Ferrando, D Bassetti (Clinica Malattie Infettive, Università di Genova, Genova, Italy), J Ruiz Contreras, A Manzanares (Hospital 12 de Octubre, Madrid, Spain), A Ruiz Extremera (Hospital Clinico San Ceciliò, Granada, Spain), F Salvini, G V Zuccotti, (Ospedale San Paolo, Milano, Italy), T Schmitz, I Grosch-Wörner, C Feiterna Sperling, T Piening (Charité Virchow-Klinikum, Berlin, Germany), H Souayah, J Levy (Hospital St Pierre, Brussels, Belgium), A Vegnente, R Iorio (Dipartimento di Pediatria, Università Federico II, Napoli, Italy), A Versace, S Garetto, E Palomba, C Gabiano, L Balbo (Dipartimento di Pediatria, Università di Torino, Torino, Italy), R Wejstal, G Norkrans (Ostra Hospital, Goteborg, Sweden), A Zanetti, E Tanzi (Università di Milano, Milan, Italy)

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