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BACKGROUND: Vertical transmission is the primary route of hepatitis C virus (HCV) infection among children. Approximately 5-10% of infants born to HCV(+) women are unable to clear the infection by 18 months and live with chronic disease. Recently, the Philadelphia Department of Public Health (PDPH) examined the scope of HCV infection in women of child-bearing age and the proportion of infants born to HCV(+) mothers who are appropriately tested. Positive HCV laboratory results have been reported to PDPH since 2003, and reporting of negative HCV RNA laboratory tests was mandated in August 2014. This study aimed to assess a HCV issue by utilizing several data sources in-house and collaborating with partners to fill HCV testing gaps in existing surveillance data.
METHODS: To assess the scale of children born to HCV(+) women, 2011-2014 birth records were matched by name and date of birth to the HCV registry. The match yielded women who are HCV(+) and gave birth during the time period and infants who had been tested for HCV. Preexisting PDPH surveillance data was enhanced by obtaining positive and negative HCV test results from Philadelphia’s two major commercial laboratories, as well as three hospital systems. Additional tests were merged with existing data, and case status assignments were updated. The final dataset was matched to Philadelphia’s immunization registry to obtain child’s contact information and vaccination history.
RESULTS: Initial matches of 87,419 births and 5,080 HCV(+) women of child-bearing age during 2011-2014 yielded 906 births to HCV(+) women. Twenty infants were found to have received HCV testing . Additional HCV test results clarified that 8% (n=403) of women, to whom 29% (n=263) of the infants were born, were HCV RNA(-) at the time of pregnancy. These datasets also included additional test results for 74 infants. Immunization records showed that 20 children (3%) had died, 7% (n=47) relocated out-of-jurisdiction, and 18% (n=113) were not up-to-date for their vaccinations.
CONCLUSIONS: This project illustrates the necessity for program collaboration, data sharing, and comprehensive test result finding beyond routine surveillance of HCV. The inclusion of additional data allowed for more accurate identification of women and children based on their HCV infection status (chronic or resolved). Parental fear and unnecessary staff efforts are deferred by minimizing misclassification, improving the validity and substance of PDPH’s perinatal HCV testing analyses. Most importantly, an at-risk population was identified and interventions will be attempted to bring them to care via a PDPH pilot project.