Hepatitis C Testing in Infants: What Happens Next?

Medically reviewed by Karen Gill, MD on September 20, 2016Written by Annette McDermott on January 14, 2016

Understanding hepatitis C

Hepatitis C is a blood-borne viral infection of the liver. It may be short-term or chronic, and there isn’t a vaccine available at this time.

In adults, the hepatitis C virus (HCV) is most commonly transmitted through exposure to contaminated needles. It can also be transmitted through infected blood products, such as blood transfusions, or unprotected sex.

The symptoms of hepatitis C may include:

  • nausea
  • jaundice
  • fever
  • joint pain
  • abdominal pain
  • dark urine
  • fatigue

Many adults don’t experience symptoms and don’t know that they’re infected.

Babies also can get the disease. Infants may contract the disease from infected mothers during the weeks leading to and during birth. Symptoms are rare in infants and young children who contract HCV at birth. In general, symptoms are uncommon in children.

Here’s what you should know about the HCV testing process in infants and how to move forward if a diagnosis is made.

What are the hepatitis C testing options for infants?

If you receive an HCV-positive result on an antibody test, it usually means you’ve been infected with HCV at some point. This also means your immune system has been triggered to fight the virus.

During the perinatal period and birth, a mother’s antibodies and some viruses, including HCV, cross the placenta and are passed on to her child. Infants born to mothers infected by HCV often test positive for HCV antibodies for up to 18 months after birth. This doesn’t necessarily mean that they have hepatitis C, though. HCV antibody tests are often inaccurate.

The antibodies present in the test may come from the infected mother and not the child. Because of this, it’s recommended that you hold off on getting an HCV antibody test for your child until after they’re at least 18 months old. By this point, any remaining antibodies from the mother should be out of the child’s system. This means a more definitive result can be obtained.

HCV RNA-PCR tests are also used. Though HCV RNA-PCR tests are considered a more reliable way to detect the virus in the blood, a two-step approach is often recommended. To determine a diagnosis, your infant will be given two HCV RNA-PCR tests at least six months apart. This test can be done after 3 months of age, though it usually isn’t done until later. If your infant tests positive on both, they will be diagnosed with HCV.

Learn more: Pregnancy and breast-feeding with hepatitis C: What you need to know »

How are the tests administered?

Both the HCV antibody test and HCV RNA test are evaluated through a blood draw.

Newborn and very young infant blood draws are often done by a quick heel or finger prick, depending on the size and weight of the child. Heel or finger pricks are typically easier to perform on infants. These sticks can be painful, though, so a less painful vein puncture is sometimes preferred. Vein puncture can be done at any age, however this may require multiple attempts and cause discomfort.

Whenever possible, vein puncture on infants should be performed by a pediatric-trained phlebotomist using a butterfly needle. Phlebotomists are trained to draw blood. You may be asked to help immobilize your child during the process. If you’d prefer not to participate, a second phlebotomist may assist.

After blood is drawn, pressure is applied to the needle entry point to ensure proper blood clotting and a bandage is applied. The area may be sore or bruise slightly. The drawn blood is labeled and sent to a lab for examination.

How common is hepatitis C in infants?

Up to 46,000 children in the United States have HCV, with many being infected from their mother during the birthing process. According to the CDC, about 6 out of every 100 babies born to infected mothers contract the disease. This risk increases if the child is born to a mother with both HCV and HIV.

Research has shown that an infant has a greater chance of HCV infection if the mother has a higher viral load. The viral load refers to the amount of virus present in your bloodstream. Cesarean delivery hasn’t been shown to change the risk of infection during birth.

What should I do if my infant tests positive for hepatitis C?

Up to 40 percent of children with HCV outgrow the illness without treatment. These children are usually free of the virus by age 2. According to the American Liver Foundation, some children up to age 7 have cleared the virus without treatment.

Infants diagnosed with HCV should receive care from a pediatric gastroenterologist or hepatologist experienced with HCV infection in babies. They’ll monitor your child’s symptoms, growth, and nutrition, and oversee regular liver function screening. Your child’s doctor will most likely recommend that they get hepatitis A and hepatitis B vaccines, as well as a flu shot.

To prevent spreading the infection, you and your family should learn how HCV is and isn’t transmitted. This will help you prepare for how to handle accidents and daily activities that may involve blood.

Keep reading: What to expect from a hepatitis C blood test »

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