POSTTRANSFUSION AND COMMUNITY-ACQUIRED HEPATITIS-C IN CHILDHOOD

Following a longitudinal study of chronic non-A, non-B hepatitis in It aly and Spain, we evaluated the epidemiologic and clinical features of chronic hepatitis C in 77 consecutively observed children (35 male; m ean age, 4 years) without underlying systemic diseases. All subjects w ere positive for antibody to hepatitis C virus in serum by second-gene ration tests. Forty-six patients had received blood transfusions in th e perinatal period; 12 had a mother with antibodies to HCV in serum (f ive of these mothers were drug users or partners of a drug user); seve n had a history of putative percutaneous exposure; and 12 had not been exposed to any risk factors for viral hepatitis. At presentation, onl y 22% were symptomatic, mean alanine-aminotransferase levels were thre e times the upper normal value, and liver histology showed active dise ase in only nine of 28 cases (32%). During a mean observation period o f 6 years, only 11 of 57 patients (19%) complained of symptoms and 11 of 40 cases (27%) had histologic features of active hepatitis. Two pat ients had severe hepatitis with associated cirrhosis. However, only si x of 57 cases (10%) achieved sustained biochemical remission. The clin ical features and the outcome were similar in both the posttransfusion and the community acquired cases. These results indicate that transfu sions in the perinatal period are the single most important cause of h epatitis C in otherwise healthy children. Community acquired cases rep resent an heterogeneous epidemiologic group in which maternal transmis sion, whether perinatal or postnatal, could be relevant. Histologicall y severe hepatitis and cirrhosis seem to be an infrequent feature of c hronic hepatitis C virus infection in childhood and adolescence, in sp ite of persistent liver damage.