Burden of pediatric hepatitis C
摘要
Hepatitis C virus(HCV)is a major health burden infecting 170-210 million people worldwide.Additional 3-4millions are newly-infected annually.Prevalence of pediatric infection varies from 0.05%-0.36%in the United States and Europe;up to 1.8%-5.8%in some developing countries.The highest prevalence occurs in Egypt,sub-Saharan Africa,Amazon basin and Mongolia.HCV has been present in some populations for several centuries,notably genotypes 1 and 2 in West Africa.Parenteral anti-schistosomal therapy practiced in the 1960s until the early 1980s had spread HCV infection throughout Egypt.Parenteral acquisition of HCV remains a major route for infection among Egyptian children.Insufficient screening of transfusions,unsterilized injection equipment and re-used needles and syringes continue to be major routes of HCV transmission in developing countries,whereas vertical transmission and adolescent high-risk behaviors(e.g.,injection drug abuse)are the major routes in developed countries.The risk of vertical transmission from an infected mother to her unborn/newborn infant is approximately 5%.Early stages of HCV infection in children do not lead to marked impairment in the quality of life nor to cognitive,behavioral or emotional dysfunction;however,caregiver stress and family system strain may occur.HCV slowly progresses to serious complications as cirrhosis(1%-2%)and hepatocellular carcinoma(HCC)especially in the presence of risk factors as hemolytic anemias,obesity,treated malignancy,and concomitant human immune deficiency and/or hepatitis B virus co-infection.HCV vaccine remains elusive to date.Understanding the immune mechanisms in patients who successfully cleared the infection is essential for vaccine development.The pediatric standard of care treatment consists of pegylated interferon-α2a or b plus ribavirin for 24-48 wk.The new oral direct acting antivirals,approved for adults,need further evaluation in children.Sustained virologic response varies depending on the viral lo