Hepatitis C Screening Guidelines

Screening of infants whose mothers have hepatitis C

Overview

• New guidelines are available at http://www.HCVGuidance.org.
• Unless screening is positive, does not require referral to Pediatric Infectious Disease (PID) Clinic.

Optional early screening

• Early screening is encouraged for all infants born to women with hepatitis C:
  • 2 to 11 months of age: HCV RNA PCR test
    • If RNA-NEGATIVE, the infant will still need an anti-HCV Ab test at 18 months of age
    • If RNA-POSITIVE. the infant is likely infected; refer to PID
  • 12 to 17 months of age: anti-HCV Ab test with reflex (if positive) to HCV RNA PCR test
    • If Ab-NEGATIVE, the baby is not infected and no further testing is indicated
    • If Ab-POSITIVE and RNA-NEGATIVE, the baby might still have maternal Ab or could have had infection that cleared; refer to PID
    • If Ab-POSITIVE and RNA-POSITIVE, the baby is likely infected; refer to PID Clinic

Required definitive screening

• Definitive screening consists of anti-HCV Ab test at 18 months of age
  • If Ab-NEGATIVE, the baby is not infected and no further testing is indicated
  • If Ab-POSITIVE, the baby may be infected; refer to PID

Also consider HIV and syphilis

• Risk factors for hepatitis C overlap with those for HIV infection and syphilis, so maternal HIV and syphilis should be considered in women with hepatitis C.
  • Mothers tested NEGATIVE for HIV and syphilis in the third trimester:
    • No screening needed unless there is reason to believe the mother was infected after the testing was done.
  • Infants whose mothers were not tested for HIV and syphilis in the third trimester:
    • HIV DNA PCR at 2 months and 4 to 6 months of age
    • RPR between birth and 2 months of age