The silent infection: should we be testing for perinatal hepatitis C and, if so, how?

Winita Hardikar, Elizabeth J Elliott and Cheryl A Jones
Med J Aust 2006; 184 (2): . || doi: 10.5694/j.1326-5377.2006.tb00114.x
Published online: 16 January 2006

We recommend screening all infants whose mothers are HCV antibody-positive

Perinatal transmission of hepatitis C virus (HCV) is the main source of newly diagnosed paediatric HCV infections in Australia.1 About 5% of infants born to women who are positive for both HCV antibody and HCV RNA during pregnancy will acquire HCV infection.2 The risk of transmission is increased by HIV coinfection during pregnancy. It is estimated that 1%–2% of women of childbearing age in Australia are infected with HCV.3 Assuming that 75% of these have chronic hepatitis and viraemia in the third trimester of pregnancy, we would expect about 75–100 new cases of vertically acquired childhood HCV infection in Australia per year. However, rates reported from national deidentified laboratory data4 and from the Australian Paediatric Surveillance Unit1 are much lower, suggesting that paediatric HCV infection may be underrecognised in Australia. We thus recommend a more standardised approach to identification and follow-up of infants exposed perinatally to HCV.

  • 1 Royal Children's Hospital, Melbourne, VIC.
  • 2 University of Sydney and The Children's Hospital at Westmead, Sydney, NSW.



We thank the other members of the Australian Paediatric Surveillance Unit (APSU) Hepatitis C Study team, in particular Ms Sue Polis, Associate Professor Greg Dore and Professor John Kaldor (National Centre for HIV and Hepatitis C Epidemiology and Clinical Research [NCHECR]) for their valuable comments, and the contributors to the APSU. The APSU Hepatitis C study is funded by the NCHECR and the Department of Health and Ageing.

  • 1. Kaldor J, Jones CA, Elliott E, et al. Hepatitis C virus infection. In: Elliott E, Cronin P, Rose D, Zurybski Y, editors. Australian Paediatric Surveillance Unit Report 2002–2003. Sydney: Australian Paediatric Surveillance Unit, 2003: 37-38.
  • 2. Conte D, Fraquelli M, Prati D, et al. Prevalence and clinical course of chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a cohort of 15,250 pregnant women. Hepatology 2000; 31: 751-755.
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  • 4. Australian National Council on AIDS Hepatitis C and Related Diseases Hepatitis C Subcommittee 2002, Hepatitis C Virus Projections Working Group. Estimates and projections of the hepatitis C virus epidemic in Australia. Sydney:ANCAHRD, 2002: 1.
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  • 7. Keeffe EB. Acute hepatitis A and B in patients with chronic liver disease: prevention through vaccination. Am J Med 2005;118 Suppl 10A: S21-S27.
  • 8. Spencer JD, Tibbits D, Tippet C, et al. Review of antenatal testing policies and practice for HIV and hepatitis C infection. Aust N Z J Public Health 2003; 27: 614-619.
  • 9. Australian National Council on AIDS Hepatitis C and Related Diseases. National Hepatitis C testing policy. Sydney: ANCAHRD, 2003. Available at: (accessed Oct 2005).
  • 10. Buttery J. Hepatitis C virus. In: Palasanthiran P, Starr M, Jones CA, editors. Management of perinatal infections. Sydney: Book House, 2002: 13-15.
  • 11. Australian Government Department of Health and Ageing. Medicare Benefits Schedule. Canberra: The Department, 2005: 592.


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