Hepatitis B and C in Pregnancy and Children: A Canadian Perspective

Abstract

In 2016, the World Health Organization released a plan to eliminate viral hepatitis as a public health threat by 2030. For Canada to achieve the recommended decreases in HBV- and HCV-related new diagnoses and deaths, an increase in services is urgently required. Identifying those at risk of, or who have acquired HBV and HCV, remains a challenge, especially with the emergence of new priority populations such as pregnant persons and children. Importantly, prenatal, and pediatric care are times when individuals are often already engaged with the healthcare system, leading to the potential for opportunistic or co-localized care and interventions. At present, Canada may not be maximizing all available virologic tools that could lead to increases in prevention, identification, improved management, or even cure. Here, we describe the continuum of care that includes preconception, prenatal, postpartum, and pediatric stages; and identify current global and Canadian recommendations, findings, and opportunities for improvement.

Maternal neighbourhood‐level social determinants of health and their association with paediatric hepatitis C screening among children exposed to hepatitis C in pregnancy

“…To date, the low HCV screening rates are not well understood. Potentially it is due to competing priorities, poor access to services including primary care shortages, living in rural settings as suggested in our findings, ongoing substance use, or that the child does not remain with the mother meaning health history may not be fully available 17,18 . Additionally, HCV generally is an asymptomatic disease, a major reason why so many go undiagnosed for years or decades.…”

“…22 Additionally, other competing priorities among patients at this time may impact whether or not HCV screening is discussed at healthcare visits. 18,21 The other authors report no conflicts.…”

“…A recent US study showed that physicians who reported general knowledge about HCV had higher odds of adherence to HCV screening guidelines for pregnant women 22 . Additionally, other competing priorities among patients at this time may impact whether or not HCV screening is discussed at healthcare visits 18,21 . Furthermore, healthcare providers may be recommending HCV screening to caregivers, and the caregivers may decline to have their children screened.…”

“…Potentially it is due to competing priorities, poor access to services including primary care shortages, living in rural settings as suggested in our findings, ongoing substance use, or that the child does not remain with the mother meaning health history may not be fully available. 17,18 Additionally, HCV generally is an asymptomatic disease, a major reason why so many go undiagnosed for years or decades. A retrospective study of 63 HCV+ pregnant persons and 123 children from New Brunswick, Canada, found no association between custodianship and paediatric HCV screening.…”

Frequency and risk factors of hepatitis B and C among pregnant women

“…However, becoming infected with HCV during infancy through the transmission of the virus from mothers to their infants has grown into one of the most prevalent methods of transmission. Injection of medicines, insufficient sanitation of medical equipment, particularly syringes and needles, unscreened blood transfusions, and perinatal transmission are also major ways that HCV is passed on 12 .…”