Hepatitis C is a liver disease that causes injury to the liver in the form of inflammation. While there is an acute form of hepatitis C, children tend to have chronic hepatitis C. The disease can go undetected for years since most people with the virus do not show symptoms initially. Hepatitis C can lead to cirrhosis and liver failure.

Causes

Hepatitis C infection is caused by the hepatitis C virus (HCV). People who may be at risk for hepatitis C are those who:

• were born to a hepatitis C-infected mother;
• have been on long-term kidney dialysis;
• have regular contact with blood at work (for instance, as a health care worker);
• received a blood transfusion before July 1992;
• received blood, blood products, or solid organs from a donor who has hepatitis C;
• share personal items such as toothbrushes and razors with someone who has hepatitis C.

Most young children with the disease were infected via maternal-fetal transmission at birth.

Symptoms

Many people infected with the hepatitis C virus do not have symptoms. If the infection has been present for many years, the liver may be permanently scarred, a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.

Exams and Tests

Blood Tests

Hepatitis C often is found during blood tests for a routine physical or other medical procedure.

Hepatitis C Antibody – suggests hepatitis C infection
Hepatitis C PCR – shows virus is present

Liver Biopsy

A liver biopsy may be recommended to determine the amount of scarring present. Your child will receive sedation medications or general anesthetic before the biopsy. These medications will prevent your child from feeling pain or anxiety or remembering the procedure. An area on the right side of your child's abdomen or upper-mid abdomen will be cleansed with an antibacterial soap. The biopsy site will then be numbed with an injection of lidocaine (numbing medicine). A pediatric GI specialist will then insert a needle through the skin and into the liver to obtain a very small piece of liver tissue. The sample will be sent to the lab to be analyzed. The doctor will apply a small pressure dressing (bandage) to the site.

After the biopsy your child will stay in or return to his/her room for four hours, when a repeat blood count is checked. (Children less than one year are observed overnight.). He or she should lie on the right side or back, depending on where the biopsy is done, for two hours. Being in bed will reduce the chance of bleeding after the biopsy. Once your child is awake and alert, he/she will be allowed to drink fluids. If fluids are tolerated, a regular diet can be restarted. For the remainder of the day, your child will need to participate in quiet activity. The results of the liver biopsy are usually available two weeks after the procedure.

Treatment

A combination of interferon and ribavirin treatment can clear the virus in more than half of treated children.

Interferon Alpha

Interferon is a protein the body normally makes to modulate the immune system and to fight viruses. It is made in pure form in the test-tube and can be given in high doses. Treatment consists of injections under the skin one to three times a week for a 12-month period. This treatment has a number of side effects which can include fevers, chills and flu-like symptoms for the first few doses, and low white blood cell and platelet counts, depression and GI symptoms. This treatment is effective only about 25 percent of the time.

Ribavirin

Interferon is given with antiviral medication, most commonly a drug called ribavirin that is taken twice daily. The major side effect is low red blood cells (anemia). (Ribavirin also causes birth defects, so women taking the drug should avoid getting pregnant during and six months following treatment.)

Rest may be recommended during the acute phase of the disease when the symptoms are most severe. All patients with hepatitis C, including children, should get vaccinated against hepatitis A and B. Do not give your child vitamins, nutritional supplements or new over-the-counter medications without first discussing it with your child’s pediatric gastroenterologist. People with hepatitis C should avoid any substances that are toxic to the liver (hepatotoxic), including alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of treatment.

When your child reaches adulthood, he or she may need a liver transplant.

Points to Remember

• Hepatitis C often produces no symptoms initially and is only detected through routine blood tests.
• Young children are most at risk from maternal-fetal transmission via a mother who is infected.
• Most children have the chronic form of hepatitis C and are treated with medications to suppress the virus; medications can have serious side effects, however, and may have to be stopped. Routine liver biopsies will allow your child’s pediatric gastroenterologist to monitor liver damage over time.
• Years of inflammation and scarring and cause cirrhosis and liver failure, often resulting in a liver transplant.

For More Information

American Liver Foundation - liverfoundation.org

Hepatitis Foundation International - hepfi.org