Evaluation of infants and children perinatally exposed to hepatitis C virus

This algorithm summarizes the approach to a child with perinatal exposure to HCV infection, ie, those born to a pregnant person with HCV infection, which is diagnosed based on a positive HCV RNA test. The same strategy is used for infants born to a pregnant person with probable HCV infection, defined as reactive HCV antibody testing if HCV results are not available.

anti-HCV: hepatitis C virus antibody; HCV: hepatitis C virus; RNA test: ribonucleic acid test (also known as nucleic acid test [NAT]).

* This also applies to perinatally exposed infants aged 7 to 17 months who have not previously been tested.

¶ For children with a negative HCV RNA (at any time point after 2 months of age), no further testing is needed unless clinically warranted (ie, clinical symptoms or signs or laboratory findings consistent with hepatitis C).

Δ Children with a positive HCV RNA test (at any time point after 2 months of age) should be referred to a clinician with expertise in HCV management. Subsequent care typically includes monitoring for signs of liver disease and retesting for HCV RNA during early childhood to determine if spontaneous clearance has occurred prior to initiating antiviral therapy (typically at age ≥3 years).

Adapted from: Panagiotakopoulos L, Sandul AL, Conners EE, et al. CDC recommendations for hepatitis C testing among perinatally exposed infants and children — United States, 2023. MMWR Recomm Rep 2023; 72:1.

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Evaluation of infants and children perinatally exposed to hepatitis C virus