HCV Neonatal testing

Question 1

Mother with current HCV infection

When should newborn be screened?

Answer 1

• HCV RNA testing at 2-3 months old
• if HCV RNA detected - repeat RNA testing at 6 months. Then anti-HCV at 12-18 months.
  Check if baby had infection, then check if cleared infection
• if HCV RNA negative - anti-HCV testing at 18 months old

If mother if HCV RNA neg, then there is no risk of transfer to baby

Ensure mother screened for HBV, and baby given vaccine. HBIG if required

Question 2

Baby born to HCV positive mother

3 months HCV RNA neg
18 months anti-HCV pos

What is next step in investigation?

Answer 2

Repeat HCV RNA testing

• if HCV RNA not detected - either resolved infection (25% will resolve spontaneously), or lingering maternal antibody. Suggest repeat in 6 months
• If HCV RNA detected - evidence of current infection

Question 3

What percentage of HCV positive mothers, will transmit HCV vertically to baby?

Answer 3

5%

HCV does not transmit vertically very well, as opposed to HBV

Transmission via breastfeeding is rare

Question 4

What is recommendation for breastfeeding in HCV RNA positive mothers?

Answer 4

Can breastfeed, but would suggest avoiding

If nipples are damaged or bleeding, then recommend against breastfeeding

Question 5

Mother is HCV RNA positive, HBsAg negative

What is recommended with regards to immunisation of newborn against HBV?

Answer 5

Suggest HBV vaccine at birth, 4 weeks, 1 year in addition to routine childhood immunisation schedule

If there is a risk they contract HCV, and theoretical higher risk of HBV infection, then HBV/HCV co-infection may be a disaster in a newborn

Canadian/ Australian guidelines recommend this. No specific recommendation in UK