Transmission of hepatitis C virus from mothers to infants: its frequency and risk factors revisited.
A total of 16,714 pregnant Japanese women were tested for antibodies against hepatitis C virus (HCV), and 163 (0.98%) were positive. None of these were infected with human immunodeficiency virus-1 (HIV-1). We conducted a prospective study to discover the rate of HCV infection in babies born to mothers who were HCV RNA-positive but had no evidence for hepatitis (so called "asymptomatic carriers"), and only 2 (2.3%) of 87 such babies became infected during follow-up. This rate was considerably lower than those from other reports which included mothers with clinically overt chronic hepatitis C. We conducted another study to follow babies born to mothers with chronic hepatitis C, and found two babies infected. All of the four infected babies were born to mothers who had HCV RNA in their circulations around delivery at high titers (greater than 5.0 x 10(6) Eq/ml by branched DNA assay). This confirmed the previous finding that virus load was an important risk factor. In addition, we found three families where mother-to-infant HCV transmission was suspected in a retrospective study by indexing HCV-infected pediatric patients. Throughout the seven families, siblings of infected babies were free from HCV infection, suggesting that maternal infection of HCV owes much to chance. Breast milk feeding was not regarded as a risk factor. We also assessed the prevalence of anti-HCV antibody among 6-year old children, and only 10 of 10,446 (0.1%) were positive, suggesting low frequency of HCV infection during the period from birth to this age.