albumin, bilirubin and coagulation tests. Persons with evidence of neutropenia, thrombocytopenia and anaemia require 1–2-weekly monitoring.
9.3 Children and adolescents
WHO deines a child as an individual 19 years of age or younger and an adolescent as a person between the ages of 10 and 19 years. In countries where adults have
a high prevalence of HCV infection, an increased prevalence in children can also be expected. In Egypt, for example, approximately 2 of children are infected.
209
This rate is substantially higher in at-risk populations, such as those exposed to medical intervention. Iatrogenic transmission has been reported in hospitals
34
and reduction of HCV transmission in health-care settings is a priority strategies for
reduction in HCV transmission as part of medical care are summarized in Table 2.3. Seroprevalence rates of 10–20 have been reported among children who
have been treated in hospital for malignancy, renal failure requiring haemodialysis, extracorporeal membrane oxygenation and those who have undergone surgical
procedures.
210-215
Treatment is licensed for children older than 2 years of age. The product literature for PEG-IFN 2a reports that paediatric subjects treated with RBV
combination therapy had a delay in weight and height increases after 48 weeks of therapy compared with baseline. However, by the end of 2 years of follow up, most
subjects had returned to baseline normative growth curve percentiles for weight and height mean weight-for-age percentile was 64 at baseline and 60 at 2
years post-treatment; mean height percentile was 54 at baseline and 56 at 2 years post-treatment.
Screening
Targeted screening is indicated for children who have had medical interventions or who have received blood products in countries where screening of blood is
not carried out routinely or where medical equipment is inadequately sterilized. Children born to mothers with HCV infection are also at risk; the risk of vertical
mother-to-child transmission is approximately 5 and is substantially higher in infants born to HIV-infected mothers 17–25.
17,18
Care
Integrated health care is a key aspect of child health-care provision. Linkage with maternal and child health services, primary care, services for PWID and, where
necessary, referral for HIV care and treatment are necessary.
Treatment
Treatment success rates are similar in adults and children, although fewer studies have been carried out in children. In particular, the use of DAAs
has been inadequately studied in children as they were excluded from the phase III studies of these medicines.
84,85
One systematic review reported on
the virological outcomes and adverse effects of IFNRBV treatment among children.
153
This review included four RCTs and 31 non-randomized studies. The overall SVR rate for PEG-IFN and RBV was 30–100, which is comparable
to SVR rates seen in adults. Adverse effects were primarily lu-like symptoms and neutropenia.
9.4 Persons with liver cirrhosis
