FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 341:866-870 September 16, 1999 Number 12 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods There are few data on the prevalence and clinical outcome of hepatitis C infection in children. We studied 458 children who underwent cardiac surgery in Munich, Germany, before 1991, when blood-donor screening for hepatitis C was introduced in Germany. Their mean age at first operation was 2.8 years; none of the children had received blood transfusions before or after cardiac surgery, and none of their mothers had antibodies to hepatitis C virus (anti-HCV). We compared these patients with 458 control subjects matched for age and sex.

Results Sixty-seven (14.6 percent) of the 458 patients who had undergone cardiac surgery had anti-HCV, as compared with 3 (0.7 percent) of the control subjects (P<0.001). At a mean interval of 19.8 years after the first operation, 37 (55 percent) of the 67 patients who were positive for anti-HCV had detectable HCV RNA in their blood. The infection had cleared in the other 30 patients, as evidenced by negative results on three polymerase-chain-reaction analyses performed at six-month intervals. Only 1 of the 37 patients who were positive for HCV RNA had elevated levels of liver enzymes; that patient had severe right-sided congestive heart failure. Of the 17 patients who underwent liver biopsies, only 3 had histologic signs of progressive liver damage. These three patients had additional risk factors: two had congestive heart failure, and the third had also been infected with hepatitis B virus.

Conclusions Children who had undergone cardiac surgery in Germany before the implementation of blood-donor screening for hepatitis C had a substantial risk of acquiring the infection. However, after about 20 years, the virus had spontaneously cleared in many patients. The clinical course in those still infected seems more benign than would be expected in people infected as adults.

Source Information

From the Departments of Pediatric Cardiology and Cardiac Surgery, German Heart Center, Technical University of Munich (M.V., H.M., J.H.); the Children's University Hospital (T.L., A.F.S.) and the Institute of Pathology (B.W.), Ludwig Maximilians University; and the Max von Pettenkofer Institute (G.F., C.K., A.Z., B.L.) — all in Munich, Germany. Presented in part at the Annual Meeting of the German Society of Pediatric Gastroenterology and Nutrition, Kloster Irsee, Germany, May 15–17, 1997; at the Annual Meeting of the European and North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition, Toulouse, France, May 27–30, 1998; at the Annual Meeting of the American Association of the Study of Liver Disease, Chicago, November 6–10, 1998; and at the Annual Meeting of the European Association of Pediatric Cardiology, Dublin, Ireland, June 10–13, 1998.

Address reprint requests to Dr. Lang at the Children's University Hospital, Pediatric Gastroenterology, Lindwurmstr. 4, D-80337 Munich, Germany, or at thomas.lang{at}kk-i.med.uni-muenchen.de.

Full Text of this Article

Related Letters:

Hepatitis C in Children
Birnbaum A. H., Shneider B. L., Moy L., Lang T., Hess J., Vogt M., Jonas M. M.
Extract | Full Text  
N Engl J Med 2000; 342:290-292, Jan 27, 2000. Correspondence

This article has been cited by other articles:

• Di Marco, V., Capra, M., Gagliardotto, F., Borsellino, Z., Cabibi, D., Barbaria, F., Ferraro, D., Cuccia, L., Ruffo, G. B., Bronte, F., Di Stefano, R., Almasio, P. L., Craxi, A. (2008). Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C. haematol 93: 1243-1246 [Abstract] [Full Text]  
• Davison, S M, Mieli-Vergani, G, Sira, J, Kelly, D A (2006). Perinatal hepatitis C virus infection: diagnosis and management.. Arch. Dis. Child. 91: 781-785 [Abstract] [Full Text]  
• Bakr, I, Rekacewicz, C, El Hosseiny, M, Ismail, S, El Daly, M, El-Kafrawy, S, Esmat, G, Hamid, M A, Mohamed, M K, Fontanet, A (2006). Higher clearance of hepatitis C virus infection in females compared with males. Gut 55: 1183-1187 [Abstract] [Full Text]  
• Kelly, D. (2006). Viral hepatitis B and C in children. JRSM 99: 353-357 [Full Text]  
• Farci, P., Quinti, I., Farci, S., Alter, H. J., Strazzera, R., Palomba, E., Coiana, A., Cao, D., Casadei, A. M., Ledda, R., Iorio, R., Vegnente, A., Diaz, G., Tovo, P.-A. (2006). Evolution of hepatitis C viral quasispecies and hepatic injury in perinatally infected children followed prospectively. Proc. Natl. Acad. Sci. USA 103: 8475-8480 [Abstract] [Full Text]  
• Zhang, M., Rosenberg, P. S., Brown, D. L., Preiss, L., Konkle, B. A., Eyster, M. E., Goedert, J. J., for the Second Multicenter Hemophilia Cohort Study, (2006). Correlates of spontaneous clearance of hepatitis C virus among people with hemophilia. Blood 107: 892-897 [Abstract] [Full Text]  
• Anand, B S, Thornby, J (2005). Alcohol has no effect on hepatitis C virus replication: a meta-analysis. Gut 54: 1468-1472 [Abstract] [Full Text]  
• Bortolotti, F, Resti, M, Marcellini, M, Giacchino, R, Verucchi, G, Nebbia, G, Zancan, L, Marazzi, M G, Barbera, C, Maccabruni, A, Zuin, G, Maggiore, G, Balli, F, Vajro, P, Lepore, L, Molesini, M, Guido, M, Bartolacci, S, Noventa, F, the Italian Observatory for Hepatitis C in childre, (2005). Hepatitis C virus (HCV) genotypes in 373 Italian children with HCV infection: changing distribution and correlation with clinical features and outcome. Gut 54: 852-857 [Abstract] [Full Text]  
• Canobio, S., Guilbert, C. M., Troesch, M., Samson, J., Lemay, M., Pelletier, V. A., Bernard-Bonnin, A.-C., Kozielski, R., Lapointe, N., Martin, S. R., Soudeyns, H. (2004). Differing Patterns of Liver Disease Progression and Hepatitis C Virus (HCV) Quasispecies Evolution in Children Vertically Coinfected with HCV and Human Immunodeficiency Virus Type 1. J. Clin. Microbiol. 42: 4365-4369 [Abstract] [Full Text]  
• Castellino, S., Lensing, S., Riely, C., Rai, S. N., Davila, R., Hayden, R. T., Fleckenstein, J., Levstik, M., Taylor, S., Dean, P. J., Kippenbrock, S., Pope, J., Carr, J., Strickland, D. K., Hudson, M. M. (2004). The epidemiology of chronic hepatitis C infection in survivors of childhood cancer: an update of the St Jude Children's Research Hospital hepatitis C seropositive cohort. Blood 103: 2460-2466 [Abstract] [Full Text]  
• Cividini, A., Cerino, A., Muzzi, A., Furione, M., Rebucci, C., Segagni, L., Gatti, M., Barnaba, V., Mondelli, M. U. (2003). Kinetics and Significance of Serum Hepatitis C Virus Core Antigen in Patients with Acute Hepatitis C. J. Clin. Microbiol. 41: 2144-2146 [Abstract] [Full Text]  
• Oliver, W. C. Jr, Beynen, F. M., Nuttall, G. A., Schroeder, D. R., Ereth, M. H., Dearani, J. A., Puga, F. J. (2003). Blood loss in infants and children for open heart operations: albumin 5% versus fresh-frozen plasma in the prime. Ann. Thorac. Surg. 75: 1506-1512 [Abstract] [Full Text]  
• Angelucci, E., Muretto, P., Nicolucci, A., Baronciani, D., Erer, B., Gaziev, J., Ripalti, M., Sodani, P., Tomassoni, S., Visani, G., Lucarelli, G. (2002). Effects of iron overload and hepatitis C virus positivity in determining progression of liver fibrosis in thalassemia following bone marrow transplantation. Blood 100: 17-21 [Abstract] [Full Text]  
• Minola, E., Prati, D., Suter, F., Maggiolo, F., Caprioli, F., Sonzogni, A., Fraquelli, M., Paggi, S., Conte, D. (2002). Age at infection affects the long-term outcome of transfusion-associated chronic hepatitis C. Blood 99: 4588-4591 [Abstract] [Full Text]  
• Kelly, D, Skidmore, S (2002). Hepatitis C-Z: recent advances. Arch. Dis. Child. 86: 339-343 [Abstract] [Full Text]  
• Hoofnagle, J. H. (2001). Therapy for Acute Hepatitis C. NEJM 345: 1495-1497 [Full Text]  
• Hadzic, N (2001). Hepatitis C in pregnancy. Arch. Dis. Child. Fetal Neonatal Ed. 84: 201F-204 [Full Text]  
• Yee, T T, Griffioen, A, Sabin, C A, Dusheiko, G, Lee, C A (2000). The natural history of HCV in a cohort of haemophilic patients infected between 1961 and 1985. Gut 47: 845-851 [Abstract] [Full Text]  
• Lackner, H., Moser, A., Deutsch, J., Kessler, H. H., Benesch, M., Kerbl, R., Schwinger, W., Dornbusch, H.-J., Preisegger, K.-H., Urban, C. (2000). Interferon-alpha and Ribavirin in Treating Children and Young Adults With Chronic Hepatitis C After Malignancy. Pediatrics 106: 53e-53 [Abstract] [Full Text]  
• Thomas, D. L., Astemborski, J., Rai, R. M., Anania, F. A., Schaeffer, M., Galai, N., Nolt, K., Nelson, K. E., Strathdee, S. A., Johnson, L., Laeyendecker, O., Boitnott, J., Wilson, L. E., Vlahov, D. (2000). The Natural History of Hepatitis C Virus Infection: Host, Viral, and Environmental Factors. JAMA 284: 450-456 [Abstract] [Full Text]  
• Strickland, D. K., Riely, C. A., Patrick, C. C., Jones-Wallace, D., Boyett, J. M., Waters, B., Fleckenstein, J. F., Dean, P. J., Davila, R., Caver, T. E., Hudson, M. M. (2000). Hepatitis C infection among survivors of childhood cancer. Blood 95: 3065-3070 [Abstract] [Full Text]  
• Aach, R. D., Yomtovian, R. A., Hack, M. (2000). Neonatal and Pediatric Posttransfusion Hepatitis C: A Look Back and a Look Forward. Pediatrics 105: 836-842 [Full Text]  
• Birnbaum, A. H., Shneider, B. L., Moy, L., Lang, T., Hess, J., Vogt, M., Jonas, M. M. (2000). Hepatitis C in Children. NEJM 342: 290-292 [Full Text]  
• Jonas, M. M. (1999). Hepatitis C Infection in Children. NEJM 341: 911-913 [Full Text]  
• Jaeckel, E., Cornberg, M., Wedemeyer, H., Santantonio, T., Mayer, J., Zankel, M., Pastore, G., Dietrich, M., Trautwein, C., Manns, M. P., the German Acute Hepatitis C Therapy Group, (2001). Treatment of Acute Hepatitis C with Interferon Alfa-2b. NEJM 345: 1452-1457 [Abstract] [Full Text]