As the rate of Hepatitis C infections among young Americans increases, so does the risk of infections in infants. The CDC reports a 22% increase between 2011 and 2014 in HCV infections in women of childbearing age, between 15-44 years. There was also a 14% increase in infections in children 2 years and younger seen during this period. Higher rates of HCV infection in childbearing women greatly increases the risk for vertical transmission of the infection from mother to child if these women become pregnant. Vertical transmission occurs in 5.8% of infants born to HCV infected mothers. Although the risk of transmission is low, it still exists, and if more infected women become pregnant still unaware of their diagnosis or without access to treatment, the number of infected babies will continue to rise.
Screening for Hepatitis C is not routine for pregnant women unless they have certain risk factors for the infection, such as an infected partner or intravenous drug use. How can this be? Why are doctors not screening for a communicable infection that affects almost 4 million Americans? This discrepancy can be attributed to several factors. Hepatitis C has been an infection commonly known to affect older Americans, particularly those in the “Baby Boomer” generation. While this is still a demographic at significantly greater risk for the infection, health care practices and policies are not keeping stride with modern shifts in infection rates in other populations. Many doctors may not be aware of the rapid rise in infections in younger women, and thus are not counseling or screening these patients, despite their increased risk. Likewise, some insurers have not expanded coverage of the HCV test to this demographic as part of routine screenings.
From a policy perspective, the CDC states in this latest MMWR report on Hepatitis C that public health authorities should consider making HCV screening routine for all pregnant women. The report also calls for expansion of HCV reporting and surveillance requirements to improve identifying and preventing the spread of the infection.
It is hopeful that as a result of this data the CDC may issue updated recommendations on HCV screenings, to include routine screening of all pregnant women. Pressure from public health officials, providers, politicians and the public will be needed to influence insurers to expand coverage of routine HCV testing to more Americans. The O’Neill Institute’s Hepatitis C Policy Project is already working with representatives from the CDC and other public health agencies to improve HCV data collection and case surveillance, in order to develop long-term strategies to reduce incidence of infection.