Florida requires health practitioners and labs report all cases of acute and chronic HCV into a database called MERLIN.  A 2012 study (link below)   showed that only about 12% of children infected with HCV in Florida had been identified between 2000-2009.   Nationwide, only about 4.9% of children with HCV had been identified.  The study  concluded that “the identification of children infected with HCV in the nation as a whole is grossly inadequate.” 

To make matters worse, in Miami-Dade County, only 1.6% of children identified with HCV were being treated by gastroenterologists.  The American Association of Pediatrics doesn’t allow open access to their Red Book on infectious diseases so I can’t see what their recommendations are.  Their advocacy section is silent on HCV.

How do children become infected? Mother-to-baby transfers? Community-acquired: hand hygiene issues? Household contacts? Health Care Associated infections (HAI)? Certainly there are many possibilities.

The AAP does have some 2009 webinar slides online on HAIs that are worth looking at.  The health practitioners in the WHITE states (in 2009) can keep their health care associated infections a secret.  North Dakota is certainly protecting health providers there with regard to their current HCV outbreak in Minot.  But its hard to keep 44 cases from a one common source completely quiet and unethical to boot.

slide 19

Slide 36

This slide is interesting because it indicated how easily “extrinsic” organisms on skin can transfer infectious diseases during invasive procedures.  The four lines are hard to see.  In the case of jet injectors,  skin to > (Next!) skin to> (Next!) etc….plus the multi-dose vial contamination, other unsafe injections, the dirty blood supply, is it any wonder that military “boomers”  constitute the largest known on-going outbreak of HCV in the U.S.?  But given that HCV is a non-issue for most public health officials, we really don’t know.

We now know that HCV is a serious threat to children as well.  Testing is cheap and easy. What’s the hold-up?  I’d like to see the VA and Tricare show leadership in making universal testing available across age groups.

Study: Delgado-Borrego-J Peds-2012-Expected and Actual Case Ascertainment and Tx Rates for Children Infected with HCV in FLA and USA