Hepatitis C Virus Testing in Perinatally Exposed Children
By
Rachel L. Epstein
Sarah Munroe
Elizabeth A. Erdman
Amy Bettano
Megan R. Curtis
Laura White
Elisha M. Wachman
Anthony Osinski
Alexander Y. Walley
Benjamin P. Linas
April 17, 2026
Clinical Scorecard: HCV Testing Recommendations for Children Exposed Perinatally
At a Glance
Category Detail
Condition Perinatal Hepatitis C Virus (HCV) infection Key Mechanisms Perinatal transmission from birthing parent with active HCV infection; maternal HCV antibody persistence until 18 months Target Population Infants born to birthing parents with active HCV infection Care Setting Pediatric outpatient and public health settings
Key Highlights
Perinatal HCV infection occurs in approximately 8% of exposed infants and is the most common transmission mode among children. CDC recommends RNA testing for HCV-exposed infants between 2 and 6 months to reduce loss to follow-up, followed by antibody testing at 18 months. Only about 30.1% of exposed infants were appropriately tested under previous guidelines, largely due to loss to follow-up. Guideline-Based Recommendations
Diagnosis
Perform HCV RNA testing between ages 2 and 6 months for infants exposed perinatally to HCV. Conduct HCV antibody testing at or after 18 months of age to confirm infection status. Management
Initiate direct-acting antiviral (DAA) treatment for children aged 3 years or older with confirmed HCV infection. No FDA-approved HCV treatment exists for children under 3 years old. Monitoring & Follow-up
Link confirmed HCV-infected children to care with appropriate clinical follow-up. Monitor infants for HCV infection status through recommended testing timelines. Risks
Loss to follow-up is a major barrier to timely diagnosis and treatment of perinatally exposed infants. Maternal HCV antibody can persist until 18 months, complicating early antibody testing. Patient & Prescribing Data
Children perinatally exposed to HCV, aged 3 years or older eligible for treatment
Direct-acting antivirals (DAAs) approved for children aged 3 years and older since 2017-2021; treatment uptake and linkage to care remain suboptimal.
Clinical Best Practices
Use RNA testing at 2-6 months to reduce loss to follow-up before antibody testing at 18 months. Ensure linkage of birthing parent-infant dyads in health records to facilitate follow-up and testing. Address sociodemographic factors and healthcare access to improve testing rates among exposed infants. References
