Poster Presentation

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Hepatitis C in children Dr Pankaj VohraNew
Delhi
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Available data
Limited US, Japan, Italy, Germany,
Turkey India NIL
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Modes of transmission
Blood and blood products Horizontal
transmission rare - 0-6 No restriction school,
day-care, contact sports (AAP in Red Book
1997) Perinatal transmission
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Vertical transmission
5 for HCV disease 15 for HCV and HIV
co-infection (viral load) No known mode of
preventing transmission Mandatory testing during
pregnancy not useful HCV check between 12-18
months HCV RNA may be negative (Pediatrics
1998102355) 50-60 chronic
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Breast feeding
Risk from breast feeding exists, but
breastfeeding is not contra-indicated (Pediatrics
1998101481) Active liver disease and high load
of virus - increase risk
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Clinical features
Acute hepatitis C - rare Fulminant hepatic
failure uncommon Cirrhosis uncommon
cause (Delhi 3.5) Autoimmune diseases,
vasculitis, cryglobulinemia, Porphyria cutanea
tarda Asymptomatic (all 41 asymptomatic)
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Natural history
Benign disease Young mothers given HCV infected
anti D 17 yrs later cirrhosis-2 (Kenny-Wal
sh et al., NEJM,1999) One time transfusion
40-50 chronic infection 67/458 (14.6) -
Anti-HCV ve 37/67 (55) - HCV-RNA ve (Vogt
et al., NEJM 1999) Children with HIV co-infection
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Natural history
Acquired during immunosuppression quiescent
Hematological high infection rates, more
damage Vertically acquired Worst outcome? 1
OLT (SPLIT Registry)
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Histology
Fibrosis is common and increases with age
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Treatment
No study from India No approved medication for
CHC by US FDA JPGN 2002 Interferon monotherapy
(3 mu/m2 TIW) 19 studies (7 abstracts) - 366
children, 105 controls ETR 54 (0-91), SR
36 (0-73) 5 spontan. Type 1 - 27 Not Type
1 - 70
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Ribavarin

• Germany
• 41 children
• 3 or 5mu/m2 TIW plus 15 mg/kg Rib - 12 m
• SR - 25 children
• 18/34 responders Type1
• 7/7 non -Type 1 responded
• Severe anemia in 1

• Turkey
• 12 children 3mu/m2 TIW plus 15 mg/kg Rib
• 10 child 3mu/m2 12m
• Hemolysis in all getting Rib 4 severe 2 stopped
• SR 6/9 and 3/8

Long term data not available appears useful EASL
Dialysis, Thalassemia
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Response to therapy
Non-type 1 Liver iron content (might take longer
to respond)
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Prevalence
0.2 in less than 12 0.4 in 12-19
years (Pediatrics 1998 101481)