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Active surveillance of hepatitis C infection in the UK and Ireland
D M Gibb1, P E Neave, P A Tookey
1Department of Epidemiology and Public Health, Institute of Child Health, London, UK. d.gibb@ctu.mrc.ac.uk
Insights
Most paediatric hepatitis C virus (HCV) infections in the UK and Ireland stem from contaminated blood products. The majority of children remain asymptomatic, highlighting a need for further research and guidelines.
Area of Science:
- Hepatology
- Virology
- Paediatric Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection in children presents unique challenges for diagnosis and management.
- Understanding the epidemiology and clinical spectrum of paediatric HCV is crucial for public health initiatives.
Purpose of the Study:
- To determine the prevalence, geographical distribution, and clinical characteristics of paediatric HCV infection in the UK and Ireland.
- To identify transmission routes and associated risk factors in children diagnosed with HCV.
Main Methods:
- A prospective, active surveillance study using monthly questionnaires distributed to consultant paediatricians across the UK and Ireland.
- Data collection occurred throughout 1997 and 1998, coordinated by the British Paediatric Surveillance Unit.
Main Results:
- 182 children with HCV infection were reported from 54 centres across eight paediatric specialties.
- The primary transmission route was contaminated blood products (n=134), followed by mother-to-child transmission (n=40).
- Most children were asymptomatic; liver histology revealed mild hepatitis in the majority of cases with available data.
Conclusions:
- Contaminated blood products are the predominant source of current paediatric HCV infections in the UK and Ireland.
- The majority of infected children are asymptomatic, emphasizing the need for long-term follow-up and natural history studies.
- Multicentre trials and development of clinical practice guidelines are essential for managing paediatric HCV.
Aim:
To investigate the prevalence, distribution, and clinical details of paediatric hepatitis C virus (HCV) infection in the UK and Ireland.
Methods:
Active monthly surveillance questionnaire study coordinated through the British Paediatric Surveillance Unit, to all consultant paediatricians in 1997 and 1998.
Results:
A total of 182 HCV infected children were reported from 54 centres and by paediatricians from eight different specialties. In 40 children HCV was acquired through mother to child transmission (MTC children); 142 were infected by contaminated blood products (n = 134), organ transplantation (n = 2), needles (n = 4), or unknown risk factor (n = 2). Intravenous drug use was the risk factor for 35 mothers of MTC children. Twelve children were coinfected with HIV and four with HBV. Recent serum aspartate aminotransferase or alanine aminotransferase values were at least twofold greater than the upper limit of normal in 24 of 152 children; this occurred in five of 11 HIV coinfected children. Liver histology, available in 53 children, showed normal (7%), mild (74%), moderate (17%), or severe (2%) hepatitis. Twenty eight children had received therapy with interferon alfa.
Conclusion:
Most current paediatric HCV infection in UK and Ireland has been acquired from contaminated blood products, and most children are asymptomatic. There is a need for multicentre trials to inform clinical practice and development of good practice guidelines in this area. Long term follow up of this cohort of HCV infected children is planned to help determine the natural history over the long term of HCV acquired during infancy and childhood.