A growing number of infants are born exposed to hepatitis C, but fewer than a third are later screened to monitor and treat the potentially fatal virus, according to a recent study based out of a hospital in Pittsburgh that experts say highlights a trend unfolding across the country.
Between 2006 and 2014, obstetrician-gynecologist Catherine Chappell and her colleagues at Magee-Women’s Hospital in Pittsburgh noticed a 60 percent increase in moms-to-be who tested positive for hepatitis C. To improve treatment for these women, Chappell wanted to develop medication that was safe to take during pregnancy. But first, she launched an epidemiological study to see how prevalent hepatitis C was in the hospital system and how staff managed babies born exposed to the virus.
Of the 10,000 infants born each year in her hospital’s system, Chappell said more than 300 infants were born to women with test-confirmed cases of hepatitis C, in the study that published Wednesday in the journal Pediatrics.
“One hundred percent should have been screened,” but Chappell said only 30 percent of those babies received follow-up care for the virus, her study found. Mothers of the infected infants were more likely to say they were struggling with opioids, the study added.
Hepatitis C, a virus that attacks the liver, is the country’s most common bloodborne infection and can be fatal if left untreated, according to the Centers for Disease Control and Prevention. An estimated 3.5 million Americans have chronic hepatitis C, and this number has increased more than two-fold in recent years, a shadow epidemic following the rise in injection drug use during the opioid crisis. What makes hepatitis C among the more difficult viruses to treat is that as many as 80 percent of people who have an acute strain of the virus show no symptoms.
Among pregnant women, the hepatitis C infection rate has risen to 3.4 per 1,000 births. If a pregnant woman shares needles or has sex with a person already infected with hepatitis C and contracts the virus, there is a 6 percent chance she will pass the virus onto her newborn. Babies, like adults, initially show no clinical signs of infection. At birth, the mother passes antibodies (the immune system’s response to the virus) to the baby, rendering efforts at early detection before hospital discharge virtually useless. While the odds are small that a mother will pass hepatitis C to her infant, there is mounting concern that the medical community isn’t doing enough to identify and treat babies who may develop chronic liver disease later in life — and that this trend demonstrates one more largely undetected complication from the opioid epidemic.
Follow-up tests are recommended at least six months after birth to determine if the mother transmitted hepatitis C to the baby. But even during well-child visits after birth, those tests often don’t happen, the study suggested.
For this study, analysis was restricted to one hospital system in Pittsburgh. But Chappell said the findings touch on challenges observed nationwide by revealing how and where can the health care system better address a complex public health crisis.
“These babies are coming into care and are not being identified as needing them to be screened,” Chappell said. “It’s not the fault of the moms.”
For years, Stephen Patrick, an assistant professor of pediatrics and health policy at Vanderbilt University, has watched as soaring opioid use has taken hold of hospital maternity wards. Today, across the country, an infant is born showing signs of neonatal abstinence syndrome every 15 minutes. Along with the rising rates of drug exposure has been an increase in infants with hepatitis C.
The rate of newborns born exposed to hepatitis C rose 89 percent from 2009 to 2014, according to a 2017 CDC analysis of the 47 states that record on birth certificates when a mother has the virus at the time of delivery (excluding Connecticut, New Jersey, Rhode Island and the District of Columbia). Patrick, who served as the study’s lead author, said he is concerned the medical community is not doing enough to identify these children.
“I worry this is a silent epidemic we’re just not capturing,” Patrick said.
There is no universal screening for hepatitis C among pregnant women, according to the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, but that is now under review.
Instead, physicians screen women who present risk factors, including those who inject drugs or have been infected with HIV. Even if they have hepatitis C, pregnant women have no recommended therapy to treat it because of the concerns over taking certain medications while carrying a child.
The medical community’s failure to screen all pregnant women for hepatitis C is a problem, said Raymond Chung, the director of the Hepatology and Liver Center at Massachusetts General Hospital, who wasn’t involved with this study. You can’t figure out if an infant has been exposed to hepatitis C if you don’t screen the pregnant woman first, he said.
“It’s not a formal recommendation, but there’s evidence and support for it to be one,” Chung said.
In 2016, the World Health Organization said Hepatitis B and C led to nearly 1.5 million deaths each year, more than HIV, malaria or tuberculosis. In a report that laid out a plan for the global elimination of the hepatitis B and C, the WHO said if nations combine prevention and treatment, the world could wipe out these two forms of viral hepatitis.
But the opioid crisis may undermine those goals in the United States, Chappell said.The health care system needs to do more to screen mothers who may have hepatitis C, so it can better track transmission to children. Otherwise, Chappell said, it will become an issue that could remain hidden for years: “We need to do better by women who are struggling with addiction because it is affecting such a huge proportion of our population.”