About 4 million Americans are infected with Hepatitis C virus (HCV), and many do not even know it. Anyone can get infected with HCV, including children.

Parents need to be aware of HCV because some groups of children are at risk of infection. Read on to find out more about HCV, the symptoms of infection, how HCV is spread, who is at risk, long-term effects, and treatments.

What is HCV?

Hepatitis C virus is a virus that can cause liver disease. Although most people recover from the initial phase of HCV infection, up to 80% of them may develop evidence of chronic liver infection that may lead to much more serious liver problems and possibly death. Hepatitis C virus is the cause of approximately 10,000 deaths each year in the United States.

What are the symptoms of HCV infection?

Infection with HCV usually begins as nothing more than a mild flulike illness (although many babies and children show no symptoms). Some people may experience one or more of the following:

• Flulike symptoms (body aches, fever, diarrhea, or nausea)
• Extreme tiredness
• Lack of appetite or weight loss
• Dark yellow urine
• Light, clay-colored bowel movements
• Stomach pain, especially in the upper right side of the abdomen
• Jaundice (a yellowing of the eyes and skin)

Infants with HCV infection also may have an enlarged liver or spleen, grow more slowly, or fail to gain weight.

If your child has some of the symptoms of HCV infection, contact your pediatrician. Be sure to tell your pediatrician if your child has been exposed to anyone with HCV. To diagnose HCV infection, your pediatrician will examine your child and test your child's blood for the virus.

How is HCV spread?

Hepatitis C virus cannot be spread by touching, hugging, or kissing. Therefore, children with HCV infection can participate in all normal childhood activities and should not be excluded from child care centers or schools. However, because it can be spread through contact with blood, parents of children with HCV infection should make sure household items such as toothbrushes, razors, nail clippers, or other items that may contain small amounts of blood, are not shared.

Hepatitis C virus also can be spread through sexual contact. Infected teens and young adults should be strongly advised to avoid having sex. If they are going to have sex, they need to use latex condoms to prevent the spread of HCV. Drinking alcohol also should be avoided by anyone with HCV infection because alcohol can speed up liver damage.

Protection from HCV infection

Adults and teens can protect themselves from HCV infection by making healthy lifestyle choices and avoiding the following:

• Having unprotected sex or sexual contact with multiple partners
• Using drugs (injecting drugs, sharing needles or other drug paraphernalia, or sniffing cocaine)
• Getting tattoos or body piercings with tools that are not sterilized

Who is at risk for HCV infection?

Those most at risk for HCV infection include the following:

• Anyone who received a blood transfusion before July 1992 or clotting concentrates derived from blood plasma before 1987, particularly children who were born premature and may have received one or more unscreened blood transfusions before July 1992
• Children who may have received solid organ transplants before July 1992
• Children who may have received extended hemodialysis for kidney disease
• Children who have used injected street drugs
• Babies born to mothers infected with HCV (Up to 5% of these infants may become infected themselves. This occurs at the time of birth, and there is no treatment that can prevent this from happening.)
• Children who have evidence of liver disease (hepatitis) but do not have hepatitis A or B virus infection
• Children adopted from mothers who may have been at risk for HCV (ie, intravenous drug users)
• Anyone who took medicines called Gammagard or Polygam between April 1993 and February 1994

The good news is that infants infected with HCV at birth often remain healthy during the first few years of life. However, more studies are needed to find out if these infants will have problems from the infection as they grow older. Research also shows that mothers infected with HCV can continue to breastfeed without risking harm to their babies.

What are the long-term effects of HCV infection?

In some children, HCV infection can lead to persistent liver disease in the form of cirrhosis or scarring of the liver. Cirrhosis occurs when the liver cells die and are replaced by scar tissue and fat. The liver eventually stops working and can no longer remove wastes from the body. Infants who develop cirrhosis of the liver because of chronic HCV infection may require a liver transplant to survive. Children infected with HCV also are at risk for developing other serious liver diseases, including liver cancer.

How is HCV infection treated?

There are a variety of medicines available for adults with HCV infection, however none of them have been approved for use in children. Vitamin supplements may be prescribed, and many infected infants are given phenobarbital, a drug used to control seizures, that also stimulates liver function. Infant formulas containing fats that are more easily digested than those in standard formulas also may be recommended. Children whose HCV infection has already caused liver damage should see a pediatric gastroenterologist or hepatologist experienced in treating liver disorders.

Hope for treatment is on the horizon. Recent medical advances may result in the testing of several new drugs for HCV infection within the next few years.

Living with HCV infection

People with HCV infection often live many years without symptoms. Many don't know they have the disease until they start to have symptoms of more advanced liver problems. Children and adolescents with HCV infection should be immunized against hepatitis A and B because infection with those other hepatitis viruses will make HCV infection much worse. At the present time, there is no vaccine to prevent hepatitis C.

Medical scientists are working hard on developing medicines to help people with HCV infection. Learning about HCV and helping your child make healthy lifestyle choices will help protect your child from getting HCV infection.

If you feel your child or adolescent may have HCV infection or may have been exposed to the virus, talk to your pediatrician.

The American Academy of Pediatrics expresses its appreciation to all those who contributed to this brochure, including Thomas N. Saari, MD, who served as principal medical reviewer, and the Committee on Infectious Diseases.

Copyright © 2003