How Does Children’s Colorado Treat Hepatitis C
Some children with hepatitis C spontaneously clear the virus without treatment. The virus infection often becomes chronic, and can cause liver scarring over the years or increase the risk of liver cancer. People with other underlying liver disease also have a higher risk of complications if also infected with hepatitis C.
Children’s Colorado also offers all currently available medical therapies for children with chronic hepatitis C infection. In addition, our liver specialists conduct clinical trials of investigational therapies for chronic hepatitis C. Currently available therapies are usually given for 6-12 months. The liver specialist will decide with you if and when medical therapy is indicated.
Treatment Guidelines In Adolescents Age 12
Treatment with ledipasvir and sofosbuvir over 12 weeks resulted in sustained viral reduction in genotypes 1, 4, 5 and 6 infections without cirrhosis or with compensated cirrhosis.
Also on the treatment table for this age group from the DORA study was an 8-week treatment course of a drug combination of glecaprevir and pibrentasvir. An FDA approval for use of these two medications quickly followed completion of this study.
There is the risk of reinfection. As such, it is important to education the adolescent group who may want to begin experimenting with drugs and sex. Thus, risk counseling is important for all adolescents to prevent transmission of the virus while awaiting HCV antiviral therapy and reinfection after sustained viral response is achieved. Use of alcohol, illegal drugs, and unprotected sex should be topics of conversation.
Teens With Hepatitis C
If your child wasn’t born with hepatitis C but got the illness in the teenage years, it likely happened from using unclean needles when injecting illicit drugs, having unsafe sex, or by coming into contact with infected blood. Up to 100,000 Americans between 12 and 19 have hepatitis C.
Without treatment, teens with hepatitis C can get cirrhosis. Although adults have a wide choice of antiviral drugs, the FDA has approved two for kids age 12 to 17:
Sofosbuvir . This drug, as with adults who take it, can cure the disease in most cases. The most common side effects are fatigue and headache.
Ledipasvir-sofosbuvir . It’s a combination antiviral drug that makes the virus disappear in up to 95% of children who use it. Your child may get side effects like diarrhea, feeling tired, or trouble sleeping.
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Can Hepatitis C Virus Be Caught
Q: From other children playing together or in the classroom or from general contact like kissing and cuddling?A: No.
Q: From a blood transfusion in hospitals today?A: There is a very low risk in Australia, but infection can occur if a blood donor was recently infected and their hepatitis C test was not yet positive.
How Do People Get Hepatitis C
HCV spreads by direct contact with an infected person’s blood and other body fluids. This can happen through:
- sharing drug needles and intranasal drug devices
- getting a tattoo or body piercing with unsterilized tools
- sexual contact
- passing of the infection from a pregnant woman to her unborn child
Children who have HCV most often acquired it as newborns from their mothers.
Thanks to blood screening and other health care precautions adopted in the early 1990s, the spread of HCV from hemodialysis, blood transfusions, or organ transplants is now rare.
It’s also rare, but possible, for someone to get HCV by sharing household items that might contain an infected person’s blood, such as razors, toothbrushes, or scissors.
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Causes And Risk Factors
Hepatitis in children has many different origins or causes. A child may contract hepatitis from exposure to a viral source. The following is a list of some of the viruses associated with hepatitis:
- Hepatitis viruses. Five main types of the hepatitis virus have been identified, including hepatitis A, B, C, D, and E.
- Cytomegalovirus . This virus is a part of the herpes virus family that can be transmitted from person to person.
- Epstein-Barr virus . The virus most commonly associated with infectious mononucleosis.
- Herpes simplex virus . Herpes can involve the face and skin above the waist, or the genitalia.
- Varicella zoster virus . Also known as chickenpox, a complication of VZV is hepatitis, although these very rarely cause hepatitis in children or infants.
- Enteroviruses. A group of viruses commonly seen in children such as coxsackie viruses and echoviruses.
- Rubella. Caused by the Rubivirus, rubella is a mild disease that causes a rash. It can cause problems for the fetus if contracted during pregnancy.
- Adenovirus. A group of viruses that commonly cause colds, tonsillitis, and ear infections in children. They can also cause diarrhea.
- Parvovirus. A virus referred to as fifth disease, which is characterized by a facial rash that is described as having a “slapped-cheek” appearance.
The following is a list of some of the diseases that may cause acute or chronic hepatitis in children:
When Your Baby Has Hepatitis C
If you’re pregnant and have hepatitis C, you can pass the virus that causes the disease to your baby during childbirth, whether you deliver vaginally or through a C-section.
There are tests available when your child is 3 months old, but many experts don’t recommend them because babies can’t be treated until they’re older.
Signs that your child has hepatitis C are:
- Dark, brownish pee
- Bruising
- Swelling in the legs
Your child may also get an enlarged liver or spleen. Your doctor will be able to check this with a physical exam or by using imaging tests.
Your doctor may suggest your child get blood tests to diagnose hepatitis C. They’re the same tests used in adults, but they’re only done in kids over the age of 2:
Anti-HCV test. It looks for specific protein antibodies in your child’s blood. It’s not foolproof though, because it doesn’t show if the hepatitis C virus is active.
HCV-RNA testor qualitative HCV test. This measures whether active hepatitis C virus is in your child’s bloodstream.
Quantitative HCV test or viral load test. It checks the amount of the virus in the blood. You’ll get results that are measured in international units per liter . Lower numbers mean the disease is easier to get under control.
Viral genotyping. This test shows which kind of hepatitis C, called a “genotype,” is causing your child’s infection.
In rare cases, your baby’s doctor may want to do an ultrasound imaging test to check for the possibility of liver cancer.
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Does Your Child Need To See A Doctor About Hepatitis C
You should take your child to the GP if your child:
- develops yellow skin or eyes this is called jaundice
- has very dark brown urine
- has stomach pain that continues longer than a few days
- comes into contact with a discarded needle.
You should also speak to your GP if you think you might have been exposed to hepatitis C during your pregnancy.
Treatment Recommendations For Age 6
For age 6 and older, sofosbuvir and velpatasvir are preferred for any genotype as long as the weight is at least 37 pounds.
The most common adverse reactions observed were fatigue and headache, similar to those observed in adults.
Hepatitis B reactivation may also occur which could result in kidney failure and even death. Health care providers should test all patients for evidence of current or prior HBV infection before initiation of Epclusa and continue to monitor the patient throughout treatment.
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What Is Hepatitis B
Hepatitis B is a more serious infection. It can lead to cirrhosis of the liver, liver failure, or liver cancer, causing severe illness and even death.
Hepatitis B virus spreads from person to person through blood or other body fluids. In the United States, this most commonly happens through unprotected sex with someone who has the disease or from injecting drugs with shared needles that aren’t sterilized. It also can be passed from an infected mother to her unborn baby.
The hepatitis B vaccine is approved for people of all ages to prevent HBV infection.
Read more about hepatitis B.
Treatment Guidelines For The Child With Hcv
If a child that tests positive initially is still positive six months later, they are considered to have a chronic HCV infection. From the time the child contracts the virus it takes about two weeks to show up in the blood, but the incubation period is likely to be six to nine months before any symptoms express if they are expressed at all.
Pegylated interferon in combination with ribavirin used to be the only approved treatment for children under 12 years of age. However, this form of treatment was fraught with problems from the start. Not only was it lacking in effectiveness, it caused hypothyroidism in many of its patients. One study observed hypothyroidism in 28% of its patients treated with interferon.
Furthermore, it was discovered that this form of treatment could induce autoimmune diseases such as autoimmune thyroid disease. Interferon is no longer recommended for any age group due to its side-effects.
Treatment regiments vary based on age, weight, medication, stage of illness and which of the 6 genotypes the child has.
Treatment protocols can be contradictory between studies and organizations. However, despite this, guidelines have been proposed for the various age groups by the Infectious Diseases Society of America.
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Information On Children And Hepatitis C
Hepatitis C wont affect your childs growth or development. Children who become infected at birth or very early in life will have already been living with the virus for a long time before they become adults if they remain untreated. This makes it very important that they are regularly monitored to assess whether they have sustained any liver damage.
Treatment
The new direct acting antiviral treatments are available for children over the age of 11. We anticipate that treatment will be available to younger children in the near future.
If you have concerns about your child accessing hepatitis C treatment please phone our helpline on 020 7089 6221, it is staffed from 10.30am to 4.30pm Monday to Friday .
When should you tell your child they have hepatitis C?
There is no easy answer to this question.
You might want to protect your child by not telling them.
You might worry that they will not understand the level of stigma and will tell inappropriate people.
You might worry that you will be unable to reassure your child about living with hepatitis C or the knowledge will unnecessarily affect their wellbeing.
These are all legitimate concerns.
If you are considering when to tell your child they are living with hepatitis C, we suggest you phone our helpline to discuss this and any other issues.
Education
Mother to child transmission
Hepatitis C has not been found to cause problems during pregnancy.
Diagnosis And Treatment For Hepatitis C In Children
In children over 2 years of age, diagnosis involves a two-step procedure: the first step is screening with an antibody test for HCV. Then, if this is positive, doctors use an RNA test for HCV to confirm the diagnosis.
The American Liver Foundation recommends that children with HCV get the vaccine for hepatitis A and B, as well as the yearly flu vaccine. They also advise the below follow-ups:
- monitoring nutrition and growth
- measuring the viral load and determining the particular strain of HCV present
- screening for liver cancer for those with significant liver disease
Another follow-up measure involves testing for the liver enzymes alanine transaminase and aspartate transaminase . These levels can sometimes become increased in most children with HCV. Those with high ALT and AST have aggressive liver disease, but others may have an aggressive form of the disease without major elevations of the enzymes.
Once a child reaches 3 years, doctors recommend antiviral treatment, according to a 2020 study. New classes of direct-acting antiviral therapies are highly effective in children, who generally tolerate them well. These medications work by targeting several protein products the HCV makes.
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Ways Hcv Cannot Spread
HCV does not spread through:
- casual contact, such as hugging or kissing
- sharing food or drink
- the air
There are also no recorded cases of breastfeeding causing transmission. This means breastfeeding an infant is safe, even if the parent has HCV.
If a persons nipples become cracked or bleed, however, they should stop breastfeeding until the skin heals completely.
HCV does not always cause symptoms. Whether it does can depend on whether someone has an acute or chronic infection, among other factors. Acute infections are short-term, while chronic infections are long-term.
The symptoms of an acute HCV infection can include:
- fever
- jaundice
- indigestion
Most children with HCV have chronic infections. In children, a chronic HCV infection is one that lasts beyond age 2.
Children with chronic HCV can remain asymptomatic until adulthood. If they do experience symptoms, they tend to be less severe than that of adults who contract the virus.
A study that monitored adults with HCV from birth over 35 years found that the disease progressed slowly, with better outcomes for those who contracted the virus early in life.
There are two tests for diagnosing HCV. The first is an antibody test. Antibodies are proteins that the immune system creates to fight viruses. If the blood contains anti-HCV antibodies, this confirms a person had HCV at some point in life.
Sometimes, doctors also perform a liver biopsy, where they extract and examine a small sample of liver tissue to assess liver health.
What Are The Long Term Effects
Children with chronic hepatitis C virus infection usually feel perfectly well. After many years of infection they may develop cirrhosis of the liver or liver cancer, but this is unusual in childhood. Chronic hepatitis C infection with liver disease and/or liver cancer is the most common reason for needing a liver transplant in adults. Children rarely need a transplant.
It is hard to predict who will go on to develop serious liver problems and so it is important for all children infected with HCV to be monitored.
Children should be immunised against other hepatitis viruses like hepatitis B and hepatitis A. It is also recommended to have a good diet, exercise, maintain a healthy weight and avoid alcohol and drugs in adult life.
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Diagnosis Of Hepatitis C
If your child experiences symptoms of cirrhosis, a pediatric gastroenterologist at Riley at IU Health can perform the following exams and tests to make a diagnosis:
- Physical exam. A pediatric specialist may find an enlarged liver or spleen during an examination of your childs body.
- Blood tests. Many blood tests are used to check for the different forms of hepatitis. Types of blood tests include:
- Liver enzyme. A liver enzyme blood test shows elevated levels of alanine transaminase and aspartate transaminase liver enzymes in patients with liver injury.
- Prothrombin time. A prothrombin time blood test measures the time it takes for plasma to clot and shows if the liver is working well.
- Hepatitis C antibody. A hepatitis C antibody blood test shows hepatitis C infection.
- Hepatitis C polymerase chain reaction. A hepatitis C polymerase chain reaction blood test shows if the hepatitis C virus is present and how much.
Recommendations For Whom And When To Treat Among Children And Adolescents With Hcv Infection
RECOMMENDED RATING Direct-acting antiviral treatment with an approved regimen is recommended for all children and adolescents with HCV infection aged 3 years as they will benefit from antiviral therapy, regardless of disease severity. I, B The presence of extrahepatic manifestationssuch as cryoglobulinemia, rashes, and glomerulonephritisas well as advanced fibrosis should lead to early antiviral therapy to minimize future morbidity and mortality. I, C
HCV-related, advanced liver disease is uncommon during childhood. However, liver disease progresses over time with increasing fibrosis severity . Although uncommon, cirrhosis occurs occasionally in children and adolescents with HCV infection. Children have a long life expectancy during which HCV complications may develop. Children and adolescents with HCV infection may also transmit the virus to others.
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What Can I Do To Prevent The Spread Of Germs
- Keep your child away from other people while he or she is sick. This is especially important during the first 3 to 5 days of illness. The virus is most contagious during this time.
- Have your child wash his or her hands often. He or she should wash after using the bathroom and before preparing or eating food. Have your child use soap and water. Show him or her how to rub soapy hands together, lacing the fingers. Wash the front and back of the hands, and in between the fingers. The fingers of one hand can scrub under the fingernails of the other hand. Teach your child to wash for at least 20 seconds. Use a timer, or sing a song that is at least 20 seconds. An example is the happy birthday song 2 times. Have your child rinse with warm, running water for several seconds. Then dry with a clean towel or paper towel. Your older child can use hand sanitizer with alcohol if soap and water are not available.
- Remind your child to cover a sneeze or cough. Show your child how to use a tissue to cover his or her mouth and nose. Have your child throw the tissue away in a trash can right away. Then your child should wash his or her hands well or use a hand sanitizer. Show your child how to use the bend of his or her arm if a tissue is not available.
- Tell your child not to share items. Examples include toys, drinks, and food.