To screen or not to screen: the hepatitis C question

Abstract

In this issue of The Journal, El-Kamary, et al report results of a study in which more than 1000 children living in the Baltimore, Maryland area were screened for hepatitis C (HCV)–0.1% were infected (anti-HCV positive). Several years ago, Miriam Alter and colleagues at the Centers for Disease Control and Prevention (CDC) used serum samples obtained during the NHANES III Survey to determine the prevalence of HCV infection in children and adults living in the United States (N Engl J Med 341:556). They found that 0.2% of the 6- to 11-year-olds in the sample were HCV-positive; the prevalence doubled to 0.4% among 12- to 19-year-olds. Among adults, the prevalence progressively rose, peaking at 3.9% in the 30- to 39-year-olds in the sample. This data, combined with the data of El-Kamary et al, indicates that universal screening of children in the population is probably not warranted. However, the CDC/NHANES data suggests that women of child-bearing age might be a reasonable target of screening during pregnancy. What would be the benefit? Antiviral therapy for HCV in adults is, at best, moderately successful, and there are no clear recommendations for the treatment of HCV-infected children. Therefore, the current best management strategy is prevention. Perinatal transmission is the major cause of new cases of HCV in children. Because obstetrical factors may be important determinants of transmission, identification of HCV infected women might lead to changes in care that could decrease the risk of HCV transmission from mother to child.