Perinatal Hepatitis C Surveillance in Kentucky, 2014

Background: 

Kentucky (KY) has seen an increase in acute Hepatitis C (HCV) cases over the last few years.  Since 2012, laboratory testing among individuals at risk for HCV transmission revealed a large number of HCV-positive tests in the 20-29 year age group.  This observation heightened concerns about the potential for mother-to-child HCV transmissions of pregnant women. The KY Adult Viral Hepatitis Prevention Program (KAVHPP) requested voluntarily reporting all HCV-positive pregnant women; all infants born to HCV-positive women; and all HCV-positive children between the ages of 0 to 5 years of healthcare providers in an attempt to monitor geographic and temporal trends of perinatal HCV transmission.

Methods:

Perinatal hepatitis reports were collected from December 20, 2013 through December 21, 2014 for hepatitis markers, laboratory information, risk factors and vaccination history of pregnant women or children under the age of five years. These data were entered and maintained in EpiInfo. Descriptive analyses were performed to understand the population at risk for perinatal HCV transmission, using SPSS v.20.

Results:

Over one year, 510 perinatal hepatitis cases (85 perinatal Hepatitis B (HBV); 425 HCV) were reported to KAVHPP.  Of the reported 425 HCV cases, 380 (89.4%) were pregnant women (14 to 47 years; mean=27 years) and 43 (10.1%) were children.   Eighteen children tested positive for HCV-antibody, of which four had a positive HCV RNA test.  Out of 357 pregnant women tested for HCV-antibody, 356 tested positive, with 70 positive and 25 negative with HCV RNA test.  One pregnant woman with negative HCV-antibody test had a positive HCV RNA test. Among 425 perinatal HCV cases, injection drug use (IDU) was reported for 163 cases, multiple sex partners for 73 cases, tattoos for 23, history of STDs for 16, and exposure to a known HBV- or HCV-positive contact for 20. One child was reported to be born in a foreign country. There were no cases with known reported positive HIV status.

Conclusions:

This report demonstrates the importance of perinatal HCV surveillance for monitoring its geographic and temporal trends of transmission in Kentucky. Perinatal HCV reporting has been included in an amendment to the reportable diseases surveillance regulation to become effective in 2015.  Further cooperation from health departments and providers is needed for successful tracking of the vulnerable population at risk in order to target resources and prevention services more appropriately throughout the Commonwealth.