Current status and unmet needs of pediatric HCV infection in Taiwan.

Hepatitis C virus (HCV) infection remains a significant global health concern, with an estimated 50 million affected individuals worldwide and approximately 1 million new infections annually. While elimination efforts have primarily targeted adults, HCV infection in children has received comparatively little attention. Globally, an estimated 3.5-5 million children live with chronic HCV. In Taiwan, although the general seroprevalence is 4-5 %, specific data on younger generations remain scarce. The prevalence was approximately 0.17 % among individuals <18 years, based on our unpublished nationwide data. Parenteral exposure, mother-to-infant transmission, and surgical interventions are key transmission routes in children. Despite the lower risk of progression in pediatric cases, chronic HCV can lead to liver fibrosis, cirrhosis, or even hepatocellular carcinoma. Fortunately, direct-acting antivirals (DAAs) have revolutionized treatment, offering >95 % sustained virologic response with excellent safety profiles in children aged ≥3 years. However, challenges persist, including lack of universal HCV screening during pregnancy, underdiagnosis in children, and delayed treatment initiation. Achieving HCV elimination in Taiwan by 2030 requires expanding pediatric-focused strategies, improving maternal screening, and enhancing public awareness to reduce transmission risks and improve long-term outcomes in children.