Despite a combination of high Hepatitis C virus (HCV) prevalence, a large adult population
and high fertility, no published estimates of the scale and contribution of vertical
transmission to HCV incidence in Pakistan exist. The objective of this study was to
estimate the number of new HCV infections occurring in Pakistan as a result of vertical
transmission. We adapted a published mathematical model based on HCV antibody
and viraemia prevalence, fertility rates, risk of HCV vertical transmission and children
mortality rates to estimate the number of infections in the 2007 and 2012 birth cohorts
nationally and in four subnational regions. We estimated that 19 708 (95% uncertainty
interval [UI]: 15 941-23 819) children were vertically infected by HCV in
2007 and 21 676 (95% UI: 17 498-26 126) in 2012. The majority of these cases
(72.9% and 72.5% in 2007 and 2012, respectively) occurred in Punjab. We estimated
that vertical transmission as a mode of exposure accounted for a quarter of HCV infections
among children under 5 years of age (25.2% in 2007 and 24.0% in 2012).
Conclusion: Our results showed that one in 260 children born in Pakistan in 2007 and
2012 acquired HCV vertically. While currently no interventions during pregnancy and
childbirth are recommended to reduce this risk, prevention, testing and treatment
strategies should be considered to reduce the burden of vertical HCV infections
among young children. Other routes of transmission appear to contribute the majority
of HCV infections among children and must also be clarified and urgently addressed.