Your Baby Can Be Tested for Hepatitis C at Two Months Now — Here Is Why That Matters, and Why Many Babies Still Miss Out

What three recent studies say about the move from testing at 18 months to testing at 2 to 6 months, and about the children who are never tested at all

If you are pregnant and living with hepatitis C, or you have recently had a baby and you have the virus, the advice about testing your child has changed. For decades, families were told to wait until their child turned 18 months old. Now a single blood test taken somewhere between two and six months of age can give an answer — and for the large majority of families, that answer is reassuring.

Three studies published between May 2025 and April 2026 explain how that change came about and how well it is working. One, from Canada, sets out the reasons for testing earlier [1]. One, from a large group of American hospitals, checks whether the early test is actually accurate [2]. And one, covering every birth in the state of Massachusetts over seven years, counts how many exposed children get tested in real life [3]. The first two are encouraging. The third is a warning.

What hepatitis C is, and what it means for a baby

Hepatitis C is a virus that lives in the liver. In adults it usually causes no symptoms for years, which is part of why so many people do not know they have it, but over decades it can scar the liver badly. It spreads through blood-to-blood contact. It can also pass from a pregnant person to their baby around the time of birth.

Two facts about that are worth holding onto. The first is that most exposed babies never become infected. Careful reviews of many studies put the chance at roughly 5 or 6 in every 100 births when the parent has hepatitis C alone [4],[1]. The second is that of the small number of babies who do become infected, some clear the virus on their own — around 20 to 30 out of every 100 do so by the age of two or three [1]. So even a baby who tests positive early is not certain to need treatment.

But the babies who stay infected can develop liver scarring while they are still children, and that scarring does not go away. That is the reason finding them matters.

Why families used to wait until 18 months

The waiting was not bureaucratic caution. It was biology. During pregnancy, a parent's antibodies — the proteins the immune system makes after meeting an infection — cross the placenta into the baby and stay in the baby's blood for many months. An antibody test in a young infant would mostly be measuring the parent's immune system, not the child's, and the research that mapped out what happens to babies exposed to hepatitis C showed those borrowed antibodies can linger well into the second year [5]. Waiting until 18 months was the only way to be sure whose antibodies were being measured. And because there was no treatment available for young children anyway, waiting seemed to cost nothing.

Two things then made that reasoning obsolete.

First, far more babies were being born to parents with hepatitis C. In the United States, the number of births complicated by hepatitis C rose roughly ten-fold between 2000 and 2019, reaching about 5 in every 1,000 births [6] — a rise closely tied to the opioid epidemic. In 2020, testing every pregnancy for hepatitis C became the recommendation, so more parents learned their status [7].

Second — and this is the part that eventually forced the change — the 18-month test was mostly not happening. Study after study found that only about a third to two-thirds of exposed children ever completed it [8],[9]. A study of 457 children in Philadelphia showed exactly where families were being lost. When the test was offered at the routine two-month check-up, 91 out of 100 families did it. Offered between 2 and 12 months, about 80 out of 100. At 12 months, 62. At 18 months, 59 [10],[1]. In Ontario, Canada, the figure at 18 months was just 23 out of 100 [1].

Read that sequence again, because it is the whole story: families were not refusing the test. They were being asked for it at an age when many children simply are not in the office. Parents recovering from opioid use disorder — a large share of this group — attend fewer routine child visits, for reasons ranging from transport and work to the fear of being judged in a waiting room [11],[1].

Meanwhile, medicine caught up. Hepatitis C is now curable with tablets taken for 8 to 12 weeks, which work in more than 95 out of 100 people, and since 2021 they have been approved for children from the age of three [1]. Suddenly, finding an infected child early bought something real. In October 2023, the United States Centers for Disease Control and Prevention replaced the 18-month antibody test with a different one: a test that looks for the virus itself, called an RNA test, done once between two and six months of age [12]. Liver and infectious-disease specialists had recommended the same shift [13].

Does the early test actually work?

That is what the 2026 American study set out to check [2]. It followed children born to parents with hepatitis C across a network of university hospitals in the United States, and looked at 333 children who had both an early RNA test and a confirming test after 18 months.

Thirteen of those children had a positive early test. All 13 were confirmed to have hepatitis C later. Of the 320 whose early test was negative, 318 were confirmed clear. Two had antibodies at 18 months but no virus in their blood — meaning they had no active infection and would not have been offered treatment.

In plain terms: a positive early test meant the child really did have the virus, and a negative early test did not lead to a single treatable child being missed. No child was wrongly told they were in the clear and sent away. An earlier study at one children's hospital had found the same thing [14]; this larger one across many hospitals confirms it.

The researchers are honest about the limits. Only 13 children in the study actually had the infection, so the estimate rests on small numbers. And the study could only include children whose families came back twice — which is, of course, the very thing that goes wrong most often.

How many children actually get tested?

Here the news is harder. The Massachusetts study linked state birth records, health insurance claims and public health data to follow 4,548 children born between 2014 and 2021 to parents with hepatitis C [3]. Among the children old enough to have completed testing, fewer than half — 42 out of every 100 — had been tested properly at all.

Worse, it was getting less common, not more. Among children born in 2014, about 46 out of 100 were tested. Among those born in 2020, about 32 out of 100. Whether a child was tested depended heavily on where they were born: at some hospitals 27 out of 100 exposed babies were tested, at others 67 out of 100.

The study also looked at which children were missed, and the answer is uncomfortable. The strongest thing predicting whether a baby got tested was whether the parent's hepatitis C was written clearly in the medical record around the time of delivery. Babies whose parents were privately insured were less likely to be tested than babies whose parents were on public insurance. Babies of Black parents were less likely to be tested than babies of white parents.

None of this means doctors are testing carelessly. It means testing has been driven by who a clinician expects to be at risk, rather than by what is actually written in the chart. And a baby whose family does not fit that expectation is the baby who gets overlooked.

Finally, of the children who were found to have hepatitis C, most were sent to a specialist — but very few had been treated by the end of the study.

What this means for your family

If you have hepatitis C and are pregnant or have a new baby, three practical things follow.

Ask for the test at the two-month visit. It is one blood draw, it can be done at a visit your baby already has, and you do not need to wait until they are 18 months old.

Make sure your baby's doctor knows. The single biggest difference between babies who get tested and babies who do not is whether the hepatitis C exposure is clearly written down and passed on. Telling your child's paediatrician directly is worth doing, even if you assume the hospital already did.

Know what the results mean. A negative RNA test is strong reassurance that your baby does not have an active infection. Some families choose an antibody test at 18 months as well, simply to close the file; that is a reasonable thing to want, and the Canadian review describes families who asked for exactly that [1]. A positive result is not an emergency — it means your child should see a specialist, be watched, and, from the age of three, can be cured.

What researchers are working on next

Nobody has yet published what testing rates look like since the 2023 change; the Massachusetts figures are the "before" picture that the "after" will be compared against [3],[15]. Researchers are also trying to understand the small group of children who have antibodies at 18 months but no virus, which needs repeated testing over time to sort out [2],[5]. And attention is turning to the last and weakest step: making sure the children who are found actually reach treatment, which remains rare worldwide [16]. A test that works is only half of a system that works — and that second half is now the part being built.

References

  1. Biondi MJ, Flemming J, van Gennip J, et al. Hepatitis C virus testing in infants, a move to early screening by HCV RNA at 2 months of age. Paediatrics & Child Health. 2025;30(5):373–378. doi:10.1093/pch/pxaf012 ↩
  2. Prasad M, Sandoval GJ, Saade GR, et al. Early Postnatal Polymerase Chain Reaction Testing in the Identification of Perinatal Transmission of Hepatitis C Virus. Clinical Infectious Diseases. 2026;81(6):1102–1105. doi:10.1093/cid/ciaf266 ↩
  3. Epstein RL, Munroe S, Erdman EA, et al. Hepatitis C Virus Testing in Perinatally Exposed Children. JAMA Network Open. 2026;9(4):e260743. doi:10.1001/jamanetworkopen.2026.0743 ↩
  4. Benova L, Mohamoud YA, Calvert C, Abu-Raddad LJ. Vertical Transmission of Hepatitis C Virus: Systematic Review and Meta-analysis. Clinical Infectious Diseases. 2014;59(6):765–773. doi:10.1093/cid/ciu447 ↩
  5. Mast EE, Hwang LY, Seto DSY, et al. Risk Factors for Perinatal Transmission of Hepatitis C Virus (HCV) and the Natural History of HCV Infection Acquired in Infancy. The Journal of Infectious Diseases. 2005;192(11):1880–1889. doi:10.1086/497701 ↩
  6. Arditi B, Emont J, Friedman AM, D'Alton ME, Wen T. Deliveries Among Patients With Maternal Hepatitis C Virus Infection in the United States, 2000–2019. Obstetrics & Gynecology. 2023;141(4):828–836. doi:10.1097/AOG.0000000000005119 ↩
  7. Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recommendations and Reports. 2020;69(2):1–17. doi:10.15585/mmwr.rr6902a1 ↩
  8. Chappell CA, Hillier SL, Crowe D, Meyn LA, Bogen DL, Krans EE. Hepatitis C Virus Screening Among Children Exposed During Pregnancy. Pediatrics. 2018;141(6):e20173273. doi:10.1542/peds.2017-3273 ↩
  9. Lopata SM, McNeer E, Dudley JA, et al. Hepatitis C Testing Among Perinatally Exposed Infants. Pediatrics. 2020;145(3):e20192482. doi:10.1542/peds.2019-2482 ↩
  10. Kuncio DE, Waterman EJ, Robison SG, Roberts A. Factors Associated With Perinatal Hepatitis C Screening Among Exposed Children: 2016–2020. Pediatrics. 2024;154(1):e2023064745. doi:10.1542/peds.2023-064745 ↩
  11. Goyal NK, Rohde JF, Short V, Patrick SW, Abatemarco D, Chung EK. Well-Child Care Adherence After Intrauterine Opioid Exposure. Pediatrics. 2020;145(2):e20191275. doi:10.1542/peds.2019-1275 ↩
  12. Panagiotakopoulos L, Sandul AL, Conners EE, Foster MA, Nelson NP, Wester C. CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023. MMWR Recommendations and Reports. 2023;72(4):1–21. doi:10.15585/mmwr.rr7204a1 ↩
  13. Bhattacharya D, Aronsohn A, Price J, Lo Re V, for the AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2023 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clinical Infectious Diseases. 2023;ciad319. doi:10.1093/cid/ciad319 ↩
  14. Gowda C, Smith S, Crim L, Moyer K, Sánchez PJ, Honegger JR. Nucleic Acid Testing for Diagnosis of Perinatally Acquired Hepatitis C Virus Infection in Early Infancy. Clinical Infectious Diseases. 2021;73(9):e3340–e3346. doi:10.1093/cid/ciaa949 ↩
  15. Panagiotakopoulos L, Miele K, Cartwright EJ, et al. CDC's New Hepatitis C Virus Testing Recommendations for Perinatally Exposed Infants and Children: A Step Towards Hepatitis C Elimination. Journal of Women's Health. 2024;33(6):695–701. doi:10.1089/jwh.2023.1114 ↩
  16. Indolfi G, Easterbrook P, Dusheiko G, et al. Hepatitis C virus infection in children and adolescents. The Lancet Gastroenterology & Hepatology. 2019;4(6):477–487. doi:10.1016/S2468-1253(19)30046-930046-9) ↩