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Women & HCV - Screen & Treat Early / Screen Pregnant Women to Prevent Transmission to Children / Women & HCV in Philadelphia / Vertical Transmission in Kentucky Up 200% & Nationally Up 68%.... public health policies needed
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"HCV Vertical Transmission Increases 68% Nationally....213% in Kentucky .....Vertical transmission occurs in 5.8%..... raises concern about increases in the number of pregnant women with HCV infection, and in the number of infants who could be exposed to HCV at birth"
CDC Reports 213% Increase in Women of Child-Bearing Age....as a result of Heroin Epidemic....
1. But in this Philadelphia study published 84% of Children Born to HCV+ Mother Are Not Tested....
2. Prenatal HCV Screening particularly for at-risk women is Recommended But Not Enforced..... all children born to HCV-infected women should be tested to rule out vertical transmission
3. see below: alcohol appears to accelerate HCV progression more in women as they have lower threshold of alcohol use that accelerates liver disease progression &
4. postmenopausal HCV+ women appears to have accelerated rates of liver disease progression showing women should be screened & treated early
Failure to Test and Identify Perinatally Infected Children Born to Hepatitis C-Positive Women - (01/27/16).....8,119 females (12-54 years) were HCV-positive and in the Hepatitis Registry. Of these, 500 (5%) had delivered ≥1 child, accounting for 537 (1%) of the 55,623 children born in Philadelphia during the study period. Eighty-four (16%) of these children had HCV testing
Prenatal screening for HCV is not routine.....American Congress of Obstetricians and Gynecologists (ACOG) recommends HCV screening for pregnant women who have risk factors such as a history of injection drug use (IDU) and/or HIV infection, many patients remain unidentified using risk-based testing criteria.....other countries, including Australia in 2013, to adopt universal prenatal HCV screening....all children born to HCV-infected women should be tested to rule out vertical transmission.....National Health and Nutrition Examination Survey (NHANES) data found that only 4.9% of expected perinatally HCV infected children were identified in the United States....likely underestimates the true burden of perinatal HCV infections.....pediatric HCV cases in Florida revealed that less than 2% of known cases had received follow-up care
This study demonstrates that a notable number of HCV-positive women are giving birth in a major US city, and the majority of their children, 84% (N=181 per year), are not being adequately tested for HCV infection......Of the births to mothers known to be HCV-positive, 20.3% (n=109) had received an HCV test during their pregnancy.......most chronically infected children are unidentified and therefore unable to be linked to specialty care. These findings support the 2012 analysis that highlighted a nationwide failure to identify HCV Ab-positive children.....The delay in identifying pediatric HCV infections can elevate a child's risk of developing adverse health consequences of prolonged infection, increase secondary transmission, and result in higher health care costs.....4.6% (N=500) of women in the Hepatitis Registry gave birth to 537 children during the study period (Table 1, Figure 1), 57% of whom had no known HCV RNA result.....At the time of this analysis, PDPH had received an HCV test result for 84 children (16%) who were born to HCV-positive women in the Registry (Figure 1, Table 1, Figure 2). Of these, 38 (45%) were adequately tested and four (5%) were identified as Confirmed Perinatal cases (all HCV-Ab and HCV RNA positive) (Figure 2)......Using the 5% vertical transmission rate, an estimated 27 children of the 537 births to HCV-positive mothers are expected to be chronically infected with HCV
CDC, Severe Increase in for mother-to-child transmission of HCV- (07/26/16)
Hepatitis skyrockets in Ky women, drugs blamed......"strongly recommends all pregnant women be tested and everyone get educated about the disease" - (08/12/16) They found hepatitis C detection among women of childbearing age rose 213 percent in Kentucky, from 275 to 862 per 100,000; compared with 22 percent nationally, or 139 to 169 per 100,000.....growing problem with drug-fueled diseases in the region
WHY
women are more likely to share needles or start using intravenous drugs with a sexual partner than men are. Its cultural among IDUs. Women may more often have unprotected sex with an HCV-infected man for various reasons. So getting women into care & treatment & providing education to protect future infection is crucial.
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Natural History and Management of Hepatitis C: Does Sex Play a Role?
Some sex distinctions influence the effects of alcohol on individuals with HCV infection......Many studies suggest that alcohol consumption accelerates liver fibrosis for individuals living with HCV infection......the threshold at which alcohol may negatively affect disease progression seems lower in women than in men.....In a prospective analysis, Hezode and colleagues [21] analyzed the relationship between reported alcohol consumption—stratified as minimal (1-20 g/d), mild (21-30 g/d), or moderate (31-50 g/d)—and liver histologic features. Not surprisingly, the proportion of patients with significant fibrosis (F2-F4) grew with increased alcohol intake. They found that the percentage of women with F2-F4 fibrosis was 31% for those with an alcohol intake of <20 g/d and 60% for those with an intake of >20 g/d (P = .02). A similar trend was seen in men, but with a higher threshold of alcohol consumption. For men, the proportion with F2-F4 disease was 32.2% at <30 g/d and increased to 65.5% at >30 g/d (P = .004) [21].
Women also have slower rates of liver disease progression than men if they become chronically infected. However, this rate of disease progression changes over time in women. Postmenopausal women have increased rates of fibrosis compared with women of reproductive age because they have lost the protective effects of estrogen. Estradiol and estrogen receptors in the liver protect hepatocytes from oxidative stress, inflammatory injury, and cell death, which all contribute to fibrosis.
The analysis of this German cohort suggests that the risk for disease progression in women changes over time. This change in disease progression has been linked to reproductive status in women with HCV infection. A retrospective analysis of a large cohort of women stratified by reproductive status found that disease progression was slow in women of reproductive age and increased significantly after menopause. Age-matched men had more severe fibrosis than women of reproductive age, in premenopause, and in early menopause. No significant difference in fibrosis was seen between women in late menopause and the age-matched men in the cohort [14].
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