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Vol. 41, No. 4-5, 1998
Issue release date: July–October 1998 (April 1999)
Intervirology 1998;41:208–212@4A}
(DOI:10.1159/000024938)

A Prospective Study on Mother-to-Infant Transmission of Hepatitis C Virus

Zanetti A.R.a · Tanzi E.a · Romanò L.a · Zuin G.b · Minola E.c · Vecchi L.d · Principi N.b
a Institute of Virology, and b Pediatrics Department IV, University of Milan, c Infectious Diseases Division, ‘Ospedali Riuniti’, Bergamo, d Biochemical Chemistry Department, ‘Ospedale S. Gerardo’, Monza, Italy
email Corresponding Author

Abstract

To assess the rate of mother-to-infant transmission of hepatitis C virus (HCV) and to identify potential risk factors for transmission, we followed up (mean 22.4 months, range 1–7.5 years) a cohort of 291 babies born to anti-HCV-positive mothers, 40 of whom were also HIV coinfected. Seventeen (5.8%) babies acquired HCV infection, but none became icteric. All babies developed chronic HCV infection with 16 babies showing elevated levels of ALT. The rate of transmission was higher in babies born to mothers coinfected with HIV than in those born to mothers with HCV alone (22.5 vs. 3.2%, p < 0.0001). No association was seen between a specific maternal HCV genotype and an increased risk of neonatal infection. The median level of HCV-RNA was higher in mothers who transmitted infection than in those who did not, although the ranges overlapped. In this study, maternal history of chronic liver disease, mode of delivery and type of feeding were not predictive of HCV infection.


 goto top of outline Key Words

  • Hepatitis C virus transmission
  • Vertical/perinatal transmission
  • Hepatitis C virus RNA

 goto top of outline Abstract

To assess the rate of mother-to-infant transmission of hepatitis C virus (HCV) and to identify potential risk factors for transmission, we followed up (mean 22.4 months, range 1–7.5 years) a cohort of 291 babies born to anti-HCV-positive mothers, 40 of whom were also HIV coinfected. Seventeen (5.8%) babies acquired HCV infection, but none became icteric. All babies developed chronic HCV infection with 16 babies showing elevated levels of ALT. The rate of transmission was higher in babies born to mothers coinfected with HIV than in those born to mothers with HCV alone (22.5 vs. 3.2%, p < 0.0001). No association was seen between a specific maternal HCV genotype and an increased risk of neonatal infection. The median level of HCV-RNA was higher in mothers who transmitted infection than in those who did not, although the ranges overlapped. In this study, maternal history of chronic liver disease, mode of delivery and type of feeding were not predictive of HCV infection.


 goto top of outline References
  1. Chen DS, Lin HH, Chang MH, Chen PJ, Sung JL: Mother-to-child transmission of hepatitis C virus. J Infect Dis 1991;164:428–429.
  2. Fortuny C, Ercilla MG, Barrera JM, Gil C, Reverter M, Bruguera M, Jimenez R, Castillo R, Rodes J: Vertical transmission of hepatitis C virus (HCV): A prospective study in infants born to HCV-seropositive mothers; in Hollinger FB, Lemon SM, Margolis HS (eds): Viral Hepatitis and Liver Disease. Baltimore, Williams & Wilkins, 1991, pp 418–419.
  3. Joung MK, Park CK, Buskell-Bales ZJ, Seef LB, Houghton M, Kuo G, Chien D, Han JH: Transmission of HCV from infected mother to infant. Proceedings of the Third International Symposium on HCV, Strasbourg, 1991, p 96.
  4. Kuroki T, Nishiguchi S, Fukuda K, Shiomi S, Monna T, Murata R, Isshiki G, Hayashi N, Shikata T, Kobayashi K: Mother-to-child transmission of hepatitis C virus. J Infect Dis 1991;164:427–429.

    External Resources

  5. Novati R, Thiers V, D’Arminio Monforte A, Maisonneuve P, Principi N, Conti M, Lazzarin A, Brechot C: Mother-to-child transmission of hepatitis C virus detected by nested polymerase chain reaction. J Infect Dis 1992;165:720–723.

    External Resources

  6. Thaler MM, Park CK, Landers DV, Wara DW, Houghton M, Veereman-Wauters G, Sweet RL, Han JH: Vertical transmission of hepatitis C virus. Lancet 1991;338:17–18.
  7. Weintrub PS, Veereman-Wauters G, Cowan MJ, Thaler MM: Hepatitis C virus infection in infants whose mothers took street drug intravenously. J Pediatr 1991;119:869–874.
  8. Reinus JF, Leikin EL, Alter HJ, Cheung L, Shindo M, Jett B, Piazza S, Shih JW: Failure to detect vertical transmission of hepatitis C virus. Ann Intern Med 1992;117:881–886.
  9. Lam JPH, McOmish F, Burns SM, Yap PL, Mok JYQ, Simmonds P: Infrequent vertical transmission of hepatitis C virus. J Infect Dis 1993;167:572–576.
  10. Zanetti AR, Tanzi E, Paccagnini S, Principi N, Pizzocolo G, Caccamo ML, D’Amico E, Cambiè G, Vecchi L, Lombardy Study Group on Vertical HCV Transmission: Mother-to-infant transmission of hepatitis C virus. Lancet 1995;345:289–290.
  11. Ohto H, Terazawa S, Sasaki N, Sasaki N, Hino K, Ishiwata C, Kako M, Ujiie N, Endo C, Matsui A, Okamoto H, Mishiro S, Vertical Transmission of Hepatitis C Virus Collaborative Study Group: Transmission of hepatitis C virus from mothers to infants. N Engl J Med 1994;330:744–750.
  12. Matsubara T, Sumazaki R, Takita H: Mother-to-infant transmission of hepatitis C virus: A prospective study. Eur J Pediatr 1995;154:973–978.
  13. Kudo T, Yanase Y, Ohshiro M, Yamamoto M, Morita M, Shibata M, Morishima T: Analysis of mother-to-infant transmission of hepatitis C virus: Quasispecies nature and buoyant densities of maternal virus populations. J Med Virol 1997;51:225–230.
  14. Ruiz-Extremera A, Gimenez-Sanchez F, Perez-Ruiz M, Torres C, Ros R, Salmeron J: Can breast milk contribute to perinatal transmission of hepatitis C virus (HCV)? J Hepatol 1995;23(suppl 1):191.
  15. Lin H, Kao J, Hsu H, Ni Y, Chang M, Huang S, et al: Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers. J Pediatr 1995;126:589–591.
  16. Zimmermann R, Perucchini D, Fauchere JC, Joller-Jemelka H, Geyer M, Huch R, Huch A: Hepatitis C virus in breast milk. Lancet 1995;345:928.
  17. Bortolotti F, Resti M, Giacchino R, Azzari C, Gussetti N, Crivellaro C, Barbera C, Mannelli F, Zancan L, Bertolini A: Hepatitis C virus infection and related liver disease in children of mothers with antibodies to the virus. J Pediatr 1997;130:990–993.
  18. Ercilla MG, Fortuny C, Roca A, Celis R, Munoz C, Barrera JM, Jimenez R, Bruguera M, Rodes J: Long-term follow-up of infants perinatally infected by hepatitis C virus. Proceedings of the 9th Triennial Symposium on Viral Hepatitis and Liver Disease, Rome, 1996, p 186.
  19. Paccagnini S, Principi N, Massironi E, Tanzi E, Romanò L, Muggiasca ML, Ragni MC, Salvaggio L: Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population. Pediatr Infect Dis J 1995;14:195–199.

    External Resources

  20. Fujisawa T, Inui A, Ohkawa T, Komatsu H, Miyakawa H, Onoue M: Response to interferon therapy in children with chronic hepatitis C. J Pediatr 1995;127:660–662.
  21. Clemente MG, Congia M, Lai ME, Lilliu F, Lampis R, Frau F, Frau MR, Faa G, Diana G, Dessi C, Melis A, Mazzoleni AP, Cornacchia G, Cao A, De Virgiliis S: Effect of iron overload on the response to recombinant interferon-alfa treatment in transfusion-dependent patients with thalassemia major and chronic hepatitis C. J Pediatr 1994;125:123–128.

    External Resources

  22. Heller S, Cerdan L, Gonzalez J, Velasco M: Treatment with recombinant interferon alfa-2B in children with chronic hepatitis C. Hepatology 1994;19:72.

 goto top of outline Author Contacts

Prof. A.R. Zanetti
Institute of Virology, University of Milan
Via Pascal 38
I–20133 Milan (Italy)
Tel. +39 02 266 3946, Fax +39 02 266 80713, E-Mail zanetti@imiucca.csi.unimi.it


 goto top of outline Article Information

Number of Print Pages : 5
Number of Figures : 4, Number of Tables : 3, Number of References : 22


 goto top of outline Publication Details

Intervirology (International Journal of Basic and Medical Virology)
Founded 1973 by J.L. Melnick; continued by F. Rapp (1986–1990); M.J. Buchmeier and C.R. Howard (1991–1993)

Vol. 41, No. 4-5, Year 1998 (Cover Date: July-October 1998 (Released April 1999))

Journal Editor: Rüdiger W. Braun, Stuttgart
ISSN: 0300–5526 (print), 1423–0100 (Online)

For additional information: http://www.karger.com/journals/int


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

To assess the rate of mother-to-infant transmission of hepatitis C virus (HCV) and to identify potential risk factors for transmission, we followed up (mean 22.4 months, range 1–7.5 years) a cohort of 291 babies born to anti-HCV-positive mothers, 40 of whom were also HIV coinfected. Seventeen (5.8%) babies acquired HCV infection, but none became icteric. All babies developed chronic HCV infection with 16 babies showing elevated levels of ALT. The rate of transmission was higher in babies born to mothers coinfected with HIV than in those born to mothers with HCV alone (22.5 vs. 3.2%, p < 0.0001). No association was seen between a specific maternal HCV genotype and an increased risk of neonatal infection. The median level of HCV-RNA was higher in mothers who transmitted infection than in those who did not, although the ranges overlapped. In this study, maternal history of chronic liver disease, mode of delivery and type of feeding were not predictive of HCV infection.



 goto top of outline Author Contacts

Prof. A.R. Zanetti
Institute of Virology, University of Milan
Via Pascal 38
I–20133 Milan (Italy)
Tel. +39 02 266 3946, Fax +39 02 266 80713, E-Mail zanetti@imiucca.csi.unimi.it


 goto top of outline Article Information

Number of Print Pages : 5
Number of Figures : 4, Number of Tables : 3, Number of References : 22


 goto top of outline Publication Details

Intervirology (International Journal of Basic and Medical Virology)
Founded 1973 by J.L. Melnick; continued by F. Rapp (1986–1990); M.J. Buchmeier and C.R. Howard (1991–1993)

Vol. 41, No. 4-5, Year 1998 (Cover Date: July-October 1998 (Released April 1999))

Journal Editor: Rüdiger W. Braun, Stuttgart
ISSN: 0300–5526 (print), 1423–0100 (Online)

For additional information: http://www.karger.com/journals/int


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Chen DS, Lin HH, Chang MH, Chen PJ, Sung JL: Mother-to-child transmission of hepatitis C virus. J Infect Dis 1991;164:428–429.
  2. Fortuny C, Ercilla MG, Barrera JM, Gil C, Reverter M, Bruguera M, Jimenez R, Castillo R, Rodes J: Vertical transmission of hepatitis C virus (HCV): A prospective study in infants born to HCV-seropositive mothers; in Hollinger FB, Lemon SM, Margolis HS (eds): Viral Hepatitis and Liver Disease. Baltimore, Williams & Wilkins, 1991, pp 418–419.
  3. Joung MK, Park CK, Buskell-Bales ZJ, Seef LB, Houghton M, Kuo G, Chien D, Han JH: Transmission of HCV from infected mother to infant. Proceedings of the Third International Symposium on HCV, Strasbourg, 1991, p 96.
  4. Kuroki T, Nishiguchi S, Fukuda K, Shiomi S, Monna T, Murata R, Isshiki G, Hayashi N, Shikata T, Kobayashi K: Mother-to-child transmission of hepatitis C virus. J Infect Dis 1991;164:427–429.

    External Resources

  5. Novati R, Thiers V, D’Arminio Monforte A, Maisonneuve P, Principi N, Conti M, Lazzarin A, Brechot C: Mother-to-child transmission of hepatitis C virus detected by nested polymerase chain reaction. J Infect Dis 1992;165:720–723.

    External Resources

  6. Thaler MM, Park CK, Landers DV, Wara DW, Houghton M, Veereman-Wauters G, Sweet RL, Han JH: Vertical transmission of hepatitis C virus. Lancet 1991;338:17–18.
  7. Weintrub PS, Veereman-Wauters G, Cowan MJ, Thaler MM: Hepatitis C virus infection in infants whose mothers took street drug intravenously. J Pediatr 1991;119:869–874.
  8. Reinus JF, Leikin EL, Alter HJ, Cheung L, Shindo M, Jett B, Piazza S, Shih JW: Failure to detect vertical transmission of hepatitis C virus. Ann Intern Med 1992;117:881–886.
  9. Lam JPH, McOmish F, Burns SM, Yap PL, Mok JYQ, Simmonds P: Infrequent vertical transmission of hepatitis C virus. J Infect Dis 1993;167:572–576.
  10. Zanetti AR, Tanzi E, Paccagnini S, Principi N, Pizzocolo G, Caccamo ML, D’Amico E, Cambiè G, Vecchi L, Lombardy Study Group on Vertical HCV Transmission: Mother-to-infant transmission of hepatitis C virus. Lancet 1995;345:289–290.
  11. Ohto H, Terazawa S, Sasaki N, Sasaki N, Hino K, Ishiwata C, Kako M, Ujiie N, Endo C, Matsui A, Okamoto H, Mishiro S, Vertical Transmission of Hepatitis C Virus Collaborative Study Group: Transmission of hepatitis C virus from mothers to infants. N Engl J Med 1994;330:744–750.
  12. Matsubara T, Sumazaki R, Takita H: Mother-to-infant transmission of hepatitis C virus: A prospective study. Eur J Pediatr 1995;154:973–978.
  13. Kudo T, Yanase Y, Ohshiro M, Yamamoto M, Morita M, Shibata M, Morishima T: Analysis of mother-to-infant transmission of hepatitis C virus: Quasispecies nature and buoyant densities of maternal virus populations. J Med Virol 1997;51:225–230.
  14. Ruiz-Extremera A, Gimenez-Sanchez F, Perez-Ruiz M, Torres C, Ros R, Salmeron J: Can breast milk contribute to perinatal transmission of hepatitis C virus (HCV)? J Hepatol 1995;23(suppl 1):191.
  15. Lin H, Kao J, Hsu H, Ni Y, Chang M, Huang S, et al: Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers. J Pediatr 1995;126:589–591.
  16. Zimmermann R, Perucchini D, Fauchere JC, Joller-Jemelka H, Geyer M, Huch R, Huch A: Hepatitis C virus in breast milk. Lancet 1995;345:928.
  17. Bortolotti F, Resti M, Giacchino R, Azzari C, Gussetti N, Crivellaro C, Barbera C, Mannelli F, Zancan L, Bertolini A: Hepatitis C virus infection and related liver disease in children of mothers with antibodies to the virus. J Pediatr 1997;130:990–993.
  18. Ercilla MG, Fortuny C, Roca A, Celis R, Munoz C, Barrera JM, Jimenez R, Bruguera M, Rodes J: Long-term follow-up of infants perinatally infected by hepatitis C virus. Proceedings of the 9th Triennial Symposium on Viral Hepatitis and Liver Disease, Rome, 1996, p 186.
  19. Paccagnini S, Principi N, Massironi E, Tanzi E, Romanò L, Muggiasca ML, Ragni MC, Salvaggio L: Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population. Pediatr Infect Dis J 1995;14:195–199.

    External Resources

  20. Fujisawa T, Inui A, Ohkawa T, Komatsu H, Miyakawa H, Onoue M: Response to interferon therapy in children with chronic hepatitis C. J Pediatr 1995;127:660–662.
  21. Clemente MG, Congia M, Lai ME, Lilliu F, Lampis R, Frau F, Frau MR, Faa G, Diana G, Dessi C, Melis A, Mazzoleni AP, Cornacchia G, Cao A, De Virgiliis S: Effect of iron overload on the response to recombinant interferon-alfa treatment in transfusion-dependent patients with thalassemia major and chronic hepatitis C. J Pediatr 1994;125:123–128.

    External Resources

  22. Heller S, Cerdan L, Gonzalez J, Velasco M: Treatment with recombinant interferon alfa-2B in children with chronic hepatitis C. Hepatology 1994;19:72.