Endorsement from FISPGHAN

The Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN) Supports the Global Effort to Eliminate Hepatitis C Infection in Children

Endorsement of the Statement from the Self-Selected Group of Pediatric Hepatologists

To whom it may concern:

There are more than 3.2 million children in the world with hepatitis C virus (HCV) infection, the majority of whom acquired from their mothers. It is a tragic irony that although we now have highly effective and safe direct-acting antiviral agents capable of curing HCV in 8-12 weeks in children as young as 3 years of age, the vast majority of these children remain undiagnosed or untreated. Consequently, they face a high lifetime risk of chronic liver disease, cirrhosis, and liver cancer. Multiple studies have shown that eliminating HCV in young children is highly cost-effective, not to mention sparing these unfortunate children from suffering and stigma.

We are therefore recommending the following to:

A. Health departments—adopt the screening recommendations of the following:

1. The American Association for the Study of Liver Diseases and the Infectious Disease Society of America (2022) to do one-time screening of all subjects <18 years of age at increased risk for HCV with anti-HCV antibody with reflex testing of HCV RNA.
2. The US Centers for Disease Control and Prevention to test all perinatally exposed infants and children aged 2-17 months, with HCV RNA.

B. Pediatric societies—educate and empower health care providers

1. To perform this screening
2. To treat all HCV-infected children 3 years of age and older

C. Corporations – work with governments to provide the necessary therapeutics and testing at the most reasonable cost basis possible for children and adolescents.

1. To developers of HCV—Real-Time PCR Testing for HCV
2. To pharmaceutical companies have obtained FDA and EMA approval for their direct-acting antiviral agents for children

D. Foundations—work with the four groups below to achieve the elimination of HCV in children worldwide

1. UNICEF
2. GATES FOUNDATION
3. IMPAACT
4. CARTER CENTER

Drafted by the following members of the Group of Pediatric Hepatologists:

• Kathleen B. Schwarz, MD, FAASLD, FNASPGHAN, Rady Children’s Hospital/UCSD/ San Diego, CA, USA
• Yen-Hsuan Ni, MD, PhD, National Taiwan University, Taiwan
• Anupam Sibal, MD, Group Medical Director, Apollo Hospitals Group, India
• Giuseppe Indolfi, MD, PhD, Meyer Children's University Hospital of Florence, Italy
• Deirdre Kelly, MD, Children’s NHS Foundation Trust, UK
• Patricia D’Alia MD, Hospital General de Niños Pedro de Elizalde, Argentina
• Carol Lezama Elecharri, MD, Hospital General de Niños Ricardo Gutierrez, Argentina
• Carmen Esther Lopez Gudel, MD, Hospital J.M. de las Rios, Venezuela.
• Natascha Silva Sandy, MD, PhD, Hospital Israelita Albert Einstein, Brazil

Management of hepatitis C virus (HCV) infection in children (for health care professionals)

Who should be screened?

• Infants born to HCV-infected mothers. The risk of transmission from mother to baby is doubled if the mother is co-infected with HIV (from 5-6% to 10-11%).
• Children and adolescents with the suspicion of chronic viral hepatitis
• Adolescents with high risks, such as intravenous drug use, or in populations with a high prevalence of the infection.
• APregnant women should be screened for HCV infection at least once during each pregnancy.

Which tests should be used in patients with maternal HCV infection?

• Anti-HCV antibody in patients aged ≥ 18 months. If positive, follow this with HCV RNA to confirm active infection.
• Nucleic acid test for HCV RNA in infants aged 2 to 6 months.

Is breastfeeding safe for the baby of an HCV-infected mother?

• Breastfeeding is considered safe in HCV-positive mothers unless there are cracked or bleeding nipples or if the mother is co-infected with HIV.

Whom to treat

• All children and adolescents with chronic HCV infection aged ≥3 years

When to treat

• Regardless of any disease activity

How to treat

• Using approved direct-acting antivirals (DAAs)

*Treatment for 12 weeks in patients without cirrhosis or 24 weeks in those who are treatment-experienced or diagnosed with compensated cirrhosis

How to monitor after the treatment

• HCV RNA (quantitative or qualitative NAT) to evaluate sustained virologic response at 12 weeks after the end of treatment

What is the efficacy and cost-effectiveness of DAAs?

• High efficacy; reported with SVR12 of >95%
• Cost-effective in children

What is the safety of DAAs?

• Rates of serious adverse events and treatment discontinuation of <1%

References

1. Panagiotakopoulos L, Sandul AL, Conners EE, et al. CDC recommendations for hepatitis C testing among perinatally exposed infants and children—United States, 2023. MMWR. Recommendations and Reports. 2023;72(4):1-21.
2. WHO. Guidelines on hepatitis B and C testing. Geneva: World Health Organization, 2017.
3. Bhattacharya D, Aronsohn A, Price J, Lo Re III V, AASLD–IDSA. Hepatitis C Guidance 2023 Update: American Association for the Study of Liver Diseases– Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection, Clin Infect Dis. 2023:ciad319.
4. WHO Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics. World Health Organization; Geneva: World Health Organization 2023.
5. Leung DH, Squires JE, Jhaveri R, et al. Hepatitis C in 2020: a North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper. J Pediatr Gastroenterol Hepatol Nutr. 2020;71(3):407-17.
6. Indolfi G, Gonzalez-Peralta RP, Jonas MM, et al. ESPGHAN recommendations on treatment of chronic hepatitis C virus infection in adolescents and children including those living in resource-limited settings. J Pediatr Gastroenterol Nutr. 2024;78(4):957-972.
7. Indolfi G, Easterbrook P, Giometto S, et al. Efficacy and safety of DAA in children and adolescents with chronic HCV infection: A systematic review and meta-analysis. Liver Int. 2024;44(3):663-81.

Protecting Children from Hepatitis C: What You Need to Know

Hepatitis C is a virus that affects the liver and can lead to serious health problems if left untreated. While it often causes no symptoms in children, early detection and treatment can prevent long-term damage.

How to Prevent Transmission

• Avoid contact with blood: Never share needles, razors, or toothbrushes that may have blood on them.
• Screen pregnant women: Mothers with hepatitis C can pass the virus to their babies. Testing during pregnancy is advised.
• Use sterile medical equipment: Ensure all injections, transfusions, and dental procedures are done safely.
• Educate teens: Raise awareness about the risks of injection drug use, unsafe tattoos, and piercings.

How to Check for Infection

• Children at risk—especially those born to infected mothers or who had certain medical procedures—should be tested.
• Step 1: A simple blood test for hepatitis C antibodies.
• Step 2: If positive, an HCV RNA test confirms if the infection is active.

How to Treat

• Hepatitis C is now curable with safe, effective oral medications called direct-acting antivirals (DAAs).
• In most cases, treatment lasts 8–12 weeks and has minimal side effects.
• Children as young as 3 years old can be treated under medical supervision.
• Early treatment prevents liver damage and ensures a healthy future.

Early detection saves lives. Testing and treatment are now simpler and more effective than ever.