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Hepatitis C is a viral infection that impacts between 2.4 and 4.7 million people in the United States alone, according to the U.S. Department of Health & Human Services. And of those individuals, the American Liver Foundation reports that an estimated 23,000 to 46,000 are children.

Unlike the hepatitis A and hepatitis B viruses, there is no vaccine to protect against the hepatitis C virus (HCV). The infection may not cause notable symptoms in kids, but if left untreated, for some kids it may lead to complications like chronic liver disease.

Here’s what you need to know about this virus, how it’s transmitted to children, and questions to ask your doctor.

HCV is a blood-borne virus that can lead to an infection in adults and children. Since it’s present in the blood, any activity that exposes a child to blood containing the virus increases the chance of transmission. The virus can be detected in the blood within 1 to 2 weeks after exposure, according to the Centers for Disease Control and Prevention.

That said, most children with HCV do not have symptoms and may go undiagnosed for much longer.

Acute hepatitis C

Acute hepatitis C is the term used to describe the initial stage of an HCV infection. Up to 40 percent of children under age 2 who acquire HCV through mother-child transmission, known as vertical transmission, may spontaneously clear or remove the virus from their body, according to the American Liver Foundation.

Read this article for more information on pregnancy and breastfeeding with an HCV infection.

Chronic hepatitis C

Chronic hepatitis C is the term used to describe the long-term disease that can develop if the virus does not clear on its own. Complications of chronic hepatitis C can include liver damage, though how long this takes and the extent of the damage is different from one child to the next.

The understanding of hepatitis C in children is somewhat limited. Why? Adults have a higher rate of contracting the virus than children. Most children who acquire the viral infection tend not to have notable symptoms or develop clinical liver disease unless they have other risk factors like:

  • immunosuppression
  • treatment with chemotherapy
  • other infections, including viral ones

Again, not all children with an HCV infection will experience symptoms. In fact, kids are less likely than adults to have symptoms. They’re also less likely than adults to develop chronic liver disease and other symptoms associated with the viral infection.

Since the disease is progressive, the younger a child is, the fewer symptoms they are likely to have. As kids get older and the disease becomes more advanced, symptoms may increase in number and severity — but not always.

These symptoms may include:

  • fatigue
  • appetite loss
  • stomach pain
  • nausea and/or vomiting
  • loose and/or light-colored stools
  • yellowing of the skin/eyes (jaundice)
  • dark/brown urine
  • hives or other itching
  • joint pain
  • muscle soreness
  • fever

Your doctor may order a blood test to see if your child has an HCV infection. And there are various tests that look for:

  • different markers of infection
  • the type of hepatitis
  • infection progression

Age is a factor to consider for diagnosis via antibody testing.

Most infants born to mothers who have hepatitis C are not tested for hepatitis until they are older than 18 months. The reason for waiting is that prior to 18 months or so, the mother’s antibodies may cross the placenta and give a positive test result regardless of whether the baby has actually acquired an HCV infection.

HCV tests include:

  • Anti-HCV test. This test measures antibodies in the blood that indicate your child was exposed to the virus.
  • HCV-RNA test (qualitative HCV test). This test looks for virus activity in your child’s blood.
  • Viral load test. This test measures the total viral load — number of particles — of the virus. This test is also ordered throughout treatment to evaluate how well treatment is working.
  • Viral genotyping. This test identifies the type of hepatitis C that your child has.

Your child’s doctor may also suggest a liver biopsy in addition to blood tests to evaluate the extent of infection in your child’s liver. However, not all children with an HCV infection will need a liver biopsy.

When babies acquire an HCV infection through transmission at birth, doctors may monitor and wait until after age 3 to see if the infection goes away without treatment. As many as 40 percent of kids in these cases may clear the hepatitis C virus on their own, according to the American Liver Foundation.

Antiviral medications used to treat the viral infection are not generally recommended for use in children under 3 years old. Instead, the doctor may simply monitor your child, especially if they remain asymptomatic.

Older children (over age 12) may take antiviral medications — interferon (injection) or a combination of interferon with ribavirin (oral) — for months to years to clear the infection. The specific treatment your child receives will depend on the genotype of the virus and how your child is responding to the medications.

If the virus does not clear with antiviral therapy, your child’s doctor may recommend a liver transplant. However, the need for a liver transplant is extremely rare in children, and there’s an increased chance that the new liver may contain the viral infection as well.

Hepatitis C may be transmitted to children who come in contact with blood containing HCV. Vertical transmission is the primary way kids are exposed to the virus. What this means is that a mother who has hepatitis C passes the virus to her unborn child.

Other ways hepatitis C is transmitted:

  • organ transplant if an organ contains HCV
  • kidney dialysis if the machine has not been properly sanitized and the virus is present
  • shared items, like toothbrushes, nail clippers, or razors, that contain HCV
  • sexual contact with a partner who has hepatitis C
  • having a substance use disorder and sharing needles that contain the virus
  • having body piercing or tattoo art done with needles containing HCV
  • blood transfusions, though the risk is minimum as of 1992 because of the introduction of stringent screening guidelines

Ways hepatitis C is not transmitted:

  • contact with unbroken skin
  • contact with air around a person who has been diagnosed with hepatitis C
  • breastfeeding (HCV-positive mother/child)

Is there a way to prevent transmission in children?

Since there is no vaccine for hepatitis C, preventing transmission focuses on avoiding activities that expose kids to blood that may contain the virus.

It only takes a very small amount of blood containing the virus to lead to an infection.

It’s important to talk with kids about:

  • not sharing personal care items or touch cuts or blood on another person
  • avoiding behaviors that may lead to negative health outcomes, such as practicing sex without a condom or another barrier method
  • seeking treatment and supportive resources if they have substance use disorder

All of these actions can help lower the chance of contracting an HCV infection.

Doctors also recommend having your child vaccinated against hepatitis A and hepatitis B. These are two other viruses that can cause infection and lead to liver damage.

Most children acquire HCV at birth through vertical transmission from their mother. Around 1 in 20 babies born to mothers with hepatitis C acquire the virus, according to the American Liver Foundation.

Of those babies with an infection, some 40 percent may clear it without treatment by the time they are 2 years old (and in some reports, as late as 7 years old).

The outlook for older kids who acquire an HCV infection through other means of transmission (needle sharing due to substance use disorder, practicing sex without a condom or another barrier method, etc.) is more similar to the outlook for adults.

Up to 80 percent of those who have hepatitis C may go on to develop a chronic infection that may progress into chronic liver disease with scarring (cirrhosis) in 20 to 30 years.

Hepatitis C is rare in children. The most common route of transmission is being born to a mother who has an HCV infection. However, despite having hepatitis C, many children may clear the virus without treatment by the time they are between ages 2 and 7 years.

You can help older children reduce their chance of acquiring an HCV infection by:

  • teaching them about practicing good personal hygiene
  • encouraging them to not share personal care items
  • talking with them about the risks associated with substance use disorder as well as medical and supportive resources that are available
  • teaching them about the importance of practicing sex with a condom or another barrier method