Hepatitis C is on the rise in women of childbearing age: A discussion with Kathleen Ly, MPH

Background:
Hepatitis C virus (HCV) infection was on the decline for years in the United States—but the incidence of HCV has recently been rising sharply. The number of reported HCV cases has nearly tripled (from 850 cases in 2010 to 2,436 cases in 2015). About 34,000 incident infections occurred in 2015, and an estimated 3.5 million Americans are currently infected with hepatitis C, according to researchers at the Centers for Disease Control and Prevention (CDC).

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This recent increase is attributed to the rise of injection drug use among younger Americans—about half of which are women of reproductive age.

“Thus, concerns have arisen about the risk for vertical transmission to infants born to HCV RNA-positive mothers, especially because an increase in the HCV detection rate has been observed in recent years among reproductive-aged women but in the absence of standard interventions to prevent HCV transmission to infants,” according to a recent article from researchers at CDC.

For this investigation, CDC researchers analyzed data from two of the largest US population data sets available to explore the implications of the current epidemic in reproductive-aged women and their babies. Although birth to an HCV-infected mother is a known risk factor for HCV infection of the infant, perinatal transmission is infrequent.

In this interview, CDC epidemiologist Kathleen Ly discusses the implications of rising numbers of HCV infection among reproductive-age women and the risk to their newborns.

MDLinx: What prompted this study? Was there anecdotal evidence that HCV was on the rise?

Ms. Ly: Previously published data have shown increases in reported cases of HCV in recent years. Additionally, a national rise in injection drug use among young persons suggests HCV is a growing threat among women of childbearing age and their babies.

MDLinx: What were the major findings of this study?

Ms. Ly: This analysis is showing that there has been an increase in the number of reported cases of HCV among women of childbearing age. This increase is leading to more children being born to HCV-infected mothers and is putting a new generation at risk for this serious, but preventable, disease.

This analysis also allowed us to estimate the number of pregnant women and infants with HCV infection. Between 2011 and 2014, an estimated 29,000 pregnant women had HCV infection and around 1,700 infants were born with HCV infection each year.

MDLinx: What implications do these findings have for reproductive-age women? And for children born with HCV infection?

Ms. Ly: These findings highlight the importance of HCV screening for women at-risk for HCV and the critical need for safe and effective treatment options for pregnant women and infants.

MDLinx: What more can physicians do to help these women and their offspring?

Ms. Ly: While treatment of HCV is generally not recommended for pregnant women, a woman diagnosed with hepatitis C during pregnancy can receive treatment to cure the infection post-partum, which will protect her health and also reduce her risk of passing on the virus in future pregnancies.

For children who acquire the infection by vertical transmission, up to 40% will clear the virus on their own (spontaneous clearance) by the time they turn two years old. But for those who don’t clear the virus, the most effective treatment is not available until they turn 12, which is why it’s so important to do more to prevent these infections and continue research to develop safe and effective treatment options for younger children and pregnant women.

About Ms. Ly: Kathleen N. Ly, MPH, is an epidemiologist at the CDC’s Division of Viral Hepatitis in Atlanta, GA.