Public Health

HCV testing advised for patients who received blood in NICU before 1992

Last Updated: 2007-02-20 15:36:56 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - It would be prudent to screen people for hepatitis C virus if they received a blood transfusion in a neonatal ICU before July 1992, conclude investigators from Anchorage, Alaska, in a report in the February Archives of Pediatrics and Adolescent Medicine.

The authors note that the risk of HCV from a transfusion is now low, but it was potentially significant before 1992 when blood banks introduced screening with the second-generation HCV antibody enzyme immunoassay.

As part of a general HCV look-back and notification program, the researchers identified 1,797 persons who received transfusion(s) in one NICU between January 1975 and July 1992. Of these, only 651 (36%) had a locatable and recent mailing address and were sent a notification letter.

HCV testing was carried out in 216 (33%) of the 651 persons sent a notification letter. Seven of the tested individuals (3%) were found to be positive for HCV antibody, with six having confirmed HCV infection (RNA positive).

"These persons, aged 13 to 26 years, were unaware of their serostatus prior to screening under this program," first author Henry H Cagle from the Alaska Native Tribal Health Consortium told Reuters Health.

When asked if they were aware of having received a blood transfusion while in the NICU, 75 of 147 responders (51%) said that they were not.

The cost for personnel and data collection/management was conservatively estimated to be $105 per person sent a notification letter, for a total program cost of $68,355.

This look-back and notification program, Cagle said, "required a large commitment of both personnel and financial resources, which resulted in a relatively low yield of at-risk persons located and tested for hepatitis C. These findings should be considered before implementation of such programs in other locales."

Similar to CDC recommendations, "we advocate that healthcare providers provide counseling and hepatitis C testing, as appropriate, for all patients with a history of blood transfusion or NICU stay before July 1992," Cagle concluded.

Dr. Maureen M. Jonas from Children's Hospital Boston notes in a related editorial that primary care providers "need to be reminded that there are, no doubt, young patients in their practices with unrecognized HCV infection."

Furthermore, "Simply asking patients whether they have a history of blood transfusions is not enough, especially when those transfusions may have been administered in the newborn period," she continues.

"As Cagle and colleagues have indicated, it may be most prudent and cost-effective to be alert to this risk and to test all individuals aged at least 14 years who had been treated in a NICU for HCV as they are recognized," Dr. Jonas writes.

Arch Pediatr Adolesc Med 2007;161:125-130, 202-203.