Risk of hepatitis C infection in neonates transfused with blood from donors infected with hepatitis C

This look-back study was undertaken to identify newborn infants who had bee n infected with the hepatitis C virus (HCV) as a result of transfusions rec eived before the introduction of routine screening in 1991 and to determine the transmission rates and persistence of transfusion-transmitted HCV infe ction acquired in the neonatal period. A total of 24 infants, transfused between 1980 and 1991, were identified as having received potentially infected blood from 11 blood donors. Ten of th e donors had been administered batches of anti-D in 1977 known to have tran smitted HCV genotype Ib infection. HCV RNA was detected in five of these do nors when tested in 1994-95; the past donations of five of the donors, who had received anti-D immunoglobulin and had serological evidence of previous HCV infection but who were PCR negative when tested in 1994-95, were consi dered of lower risk. The source and time of acquisition of HCV infection fo r the one remaining donor in the study was not determined. Twenty-one (88%) of the 24 children were living at time of lookback. The me dian age at transfusion was 12 days. The median age at time of testing was 6.3 years. One child, who tested negative, was excluded from further analys is of HCV transmission, due to incomplete transfusion records. Overall, 12 of 20 (60%) children tested were positive for anti-HCV and seven (35%) were HCV RNA positive. Twelve (71%) of the 17 recipients of viraemic blood were ELISA positive and seven (41%) were PCR positive. Resolved HCV infection, as determined by ELISA pos, RIBA pos or indeterminate and PCR negativity, o ccurred in five of 12 (42%). In many instances there was more than one reci pient per HCV infected donation. All of the reported children are clinicall y asymptomatic. However, the duration of HCV infection is relatively short and there is evidence of a degree of hepatitis in five of the seven childre n who are HCV RNA positive as judged by mildly elevated transaminase levels . The three who have undergone liver biopsy show mild hepatitis. The lower rates of persistence of HCV infection in this study may be due to the young age at exposure or to the source of infection which for all but one of the children was linked to one HCV genotype from female donors. Shar ing of units of blood among multiple infants should be discouraged.