Peer Review Process for Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children

On October 31, 2023, CDC published recommendations for hepatitis C testing among perinatally exposed infants and children. Peer review was used to ensure that the quality of the published information meets the standards of the scientific community. Peer review is a form of deliberation involving an exchange of judgements about appropriateness of methods used for guideline development and the strength of the inferences drawn. Peer review involves the review of a draft product for quality by experts in the field who were not involved in producing the draft.  This page explains the peer review process. 

Purpose of report: Provide US health care providers with recommendations for testing perinatally exposed infants and children for hepatitis C. The report will serve as a resource for those involved in the development, implementation, delivery, and evaluation of clinical and preventive services, including health care professionals, public health officials, and professional, academic, public health and advocacy organizations.

Type of dissemination: Influential Scientific Information (ISI)

Timing of review: 10/17/2022-11/16/2022

Type of review: Individual

Peer reviewers provided with public comments before review? No; public comments were solicited during the same period the peer review was conducted.

Anticipated number of reviewers: Six

Primary disciplines of expertise: Pediatrics, hepatology, obstetrics, family medicine, infectious disease

Reviewers selected by (agency or designated outside organization): CDC selected reviewers from among those nominated by select organizations: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Public nomination requested for reviewers? No

Charge to peer reviewers: CDC intends to publish recommendations for hepatitis C testing among perinatally exposed infants and children in the US based on scientific evidence of effectiveness, economic value, and expert opinion. The recommendations constitute influential scientific information that will have a clear and substantial impact on public policies and private sector decisions. US Federal Information Quality Regulations require peer review of the draft recommendations, before publication, by specialists in the field who were not involved in their development, to ensure the quality, objectivity, utility, and integrity of information disseminated by federal agencies.

These recommendations describe comprehensive systematic reviews of the literature that were conducted, analyzed, and assessed to examine the availability and quality of the evidence regarding perinatal hepatitis C prevalence and testing, and health benefits and harms associated with NAT for HCV RNA at age 2-6 months compared to HCV antibody testing at or after age 18 months among perinatally exposed infants and children. Systematic evidence reviews informed the perinatal hepatitis C testing recommendation that was drafted.

For critical appraisal of the recommendations, peer reviewers were asked to:

• Evaluate the clarity of the text of the recommendations and the likelihood that these implemented recommendations will increase testing and reduce the burden of undiagnosed perinatal hepatitis C in the United States;
• Evaluate the appropriateness of the methods used to develop these recommendations and the links between the recommendation language with the strength of the evidence of the effectiveness and economic value;
• Point out any omissions from the body of evidence collected from the scientific literature;
• Identify any residual biases, errors of omission, or inconsistencies in the interpretations, findings, and conclusions;
• Assess the reasonableness of expert judgements made in the absence of empirical scientific evidence;
• Ensure that scientific uncertainties are clearly identified and characterized, and that the potential implications of any uncertainties for the proposed recommendations are clear; and
• Assess whether the authors sufficiently acknowledge limitations in the evidence used to develop the recommendations and any limitations of the recommendations themselves for the intended purpose of testing infants and children for perinatal HCV infection in the United States.

CDC also welcomed other comments, for example, on improving recommendation implementation or uptake, or other suggestions about the use of terminology, etc.

After receiving comments from reviewers, CDC provided responses to each and posted without attribution to CDC Stacks.

Peer Reviewers:

Elizabeth Barnett, MD, FAAP
Current position: Professor of Pediatrics (Infectious Diseases)
Organizational affiliation(s): Boston University Aram V. Chobanian & Avedisian School of Medicine

Ravi Jhaveri, MD, FIDSA, FPIDS
Current position: Division Head, Pediatric Infectious Diseases, Professor of Pediatrics
Organizational affiliation(s): Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago

Gwen Lazenby, MD, MSCR
Current position: Professor of Medicine and Obstetrics and Gynecology
Organizational affiliation(s): Medical University of South Carolina (MUSC)

Christine Lee, MD, MPH
Current position: Assistant Professor of Pediatrics (Gastroenterology, hepatology and nutrition)
Organizational affiliation(s): Harvard Medical School, Boston Children’s Hospital

Wael Mourad, MD, MHCM, CHCQM, FAAFP
Current position: Clinical Professor of Community and family medicine, Chief Health Officer – Health Partnership clinic, Medical Director – the Medina Clinic
Organizational affiliation(s): University of Missouri – Kansas City School of Medicine

Adam Ratner, MD, MPH
Current position: Director, Division of Pediatric Infectious Diseases, Associate Professor of Pediatrics and Microbiology
Organizational affiliation(s): New York University Grossman School of Medicine, Hassenfeld Children’s Hospital