Hi, this is Tom and in this episode I'm going to be going through Hepatitis C in children.

And you can find notes at 0.0.2finals.com and in the 0 to Finals Pediatrics book.

And you can find flashcards and questions at members.0.0.5.com.

So let's jump straight in. Hepatitis C is an RNA virus. It's mainly spread through blood-to-blood contact, such as sharing needles. No vaccine is

available. It's curable with direct- acting antiviral treatment, which is available from

age three. Let's talk about vertical transmission. Hepatitis C is passed from mothers with

detectable hepatitis V RNA to their babies around 5% of the time, depending on the mother's viral load.

The risk is significantly higher if the mother also has HIV.

Ideally, women should be treated before they become pregnant.

Hepatitis C antivirals are not recommended in pregnancy.

There's no vaccine or immunoglobulin which can help to reduce vertical transmission and caesarian section is not recommended solely to reduce transmission.

Avoiding invasive fetal monitoring and unnecessary prolonged rupture of membranes may reduce blood exposure during

labour and delivery. The Hepatitis C antibody test is not reliable until the infant is

18 months of age, as maternal antibodies may still be present in the body.

Hepatitis C RNA testing can be performed earlier in infancy, for example from two months of age, to detect infection.

Breastfeeding has not been found to spread hepatitis C.

However, if the nipples become cracked or bleed,

breastfeeding should be temporarily stopped while they heal. About 25 to 40% of vertically

infected children spontaneously clear hepatitis C by around four years of age. The remainder

develop chronic hepatitis C infection.

Let's talk about management in children.

Most babies and children are asymptomatic and they have little liver disease during childhood.

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