Hepatitis C virus (HCV) among children in the Unites States is relatively uncommon. Data from the Centers for Disease Control and Prevention’s (CDC) surveys (NHANES-III) state that about 0.17 percent of 6- to 11-year-olds and 0.39 percent of 12- to 19-year-olds are hepatitis C antibody-positive. This amounts to roughly 23,000 to 46,000 children with chronic HCV.
The most common way children acquire hep C is from HCV-positive mothers, transmitted during pregnancy or delivery. Known as vertical transmission, approximately 6 percent of infants with HCV-positive mothers will acquire the virus this way. Up to 4,000 children in the U.S. contract HCV vertically every year. Click here for more information about hepatitis C acquired during pregnancy.
The other common way that kids are infected with hep C is via drug use, which is occurring in adolescents at alarming rates. Because of this, some experts believe that the number of children who are infected is actually much higher than what is reported in the CDC survey. First, the NHANES-III used data from collected from 1988-1994. In recent years, we’ve seen a significant increase in hepatitis C due to the opioid epidemic. One recent study demonstrated a 364% increase in HCV infection among people 12 to 29 years of age living in the Appalachian region of the United States.
Generally, hepatitis C progression in children is not as severe or as rapid as it is in adults. However, significant fibrosis or cirrhosis may occur and there is a 26-fold increased risk of liver-related death associated with chronic HCV acquired in childhood. Pediatric liver transplantation from HCV is rare. Hepatocellular carcinoma (liver cancer) is extremely uncommon in HCV-positive children.
Cognitive impairment has been observed in children with HCV. This includes developmental delay, learning disorders and cognitive deficits. Children are less likely than adults to have HCV extrahepatic manifestations, such as glomerulonephritis (a kidney disease), which may occur with chronic HCV.
Hepatitis C Treatment for Children
On April 7, 2017, the U.S. Food and Drug Administration expanded the use of Sovaldi and Harvoni to adolescents 12 years and older who live with hepatitis C. Harvoni was approved for teens with genotype 1, 4, 5 or 6 chronic HCV infection; Sovaldi was approved in combination with ribavirin, for those with genotype 2 or 3 chronic HCV infection.
The only FDA-approved HCV treatment for children under age 12 is peginterferon plus ribavirin. Children with genotype 2 or 3 need 24 weeks of treatment; everyone else must endure 48 weeks. Response rates are slightly more than 50 percent. Genotype 1 patients have the lowest rates (47 percent). Side effects, including neuropsychiatric ones (depression, moodiness), are common and can be quite severe.
Although the FDA has only approved direct-acting antiviral therapy for teens, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommends some exceptions to this. Click here to read their medical management and treatment recommendations. Some pediatric liver specialists will prescribe HCV treatment off-label, but insurance companies may not cover the cost.
Pediatric clinical trials using the new direct-acting antivirals (DAAs) are reporting high cure rates and mild side effects. For instance, research presented at the 2018 Liver Meeting reported that Harvoni was safe for 3- to 5-year-olds with hepatitis C. Click here for information about hepatitis C clinical trials.
Social Issues and Stigma
Hepatitis C doesn’t just affect the body; it affects social systems. Having hepatitis C may complicate a child’s social systems. The child’s parents may be worried. Kids may not have the maturity to deal with the implications of living with a chronic, infectious disease. Keeping others safe is a tricky issue, and these issues differ if you are 5 versus 15 years old. Conversations about sex and drugs are more complicated when you have a potentially infectious virus. Telling an HCV-positive kid to avoid alcohol is an even more serious discussion than it already is with kids who have healthy livers.
Stigma may be especially cruel for kids who have hep C. People aren’t always kind to others who have potentially infectious diseases. Adults and children may be ignorant about how hepatitis C is transmitted. Infected kids have been isolated while playing sports, in their classrooms and during social activities.
There is little information about HCV in the pediatric population. Resources about children with hep C are outdated. These are the best:
- American Association for the Study of Liver Diseases and the Infectious Diseases Society of America’s HCV in Children
- NASPGHAN Practice Guidelines: Diagnosis and Management of Hepatitis C Infection in Infants, Children, and Adolescents – Cara L. Mack, et al. Journal of Pediatric Gastroenterology and Nutrition Volume 54, Number 6, June 2013
- PKIDS – Parents of Kids with Infectious Diseases – Pkids.org
Last Reviewed: March 5, 2019