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Hepatitis B and C in Children

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Abstract

The diagnosis and treatment of infection with hepatitis B and C has undergone a paradigm shift in the past decade. Although children with these infections are usually asymptomatic with normal liver function, their evaluation and management can often involve complex issues and require specialized expertise. Here the authors review the common clinical scenarios which might be encountered by a general pediatrician, explain the various tests available for diagnosis, and provide practical guidelines for managing these children.

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References

  1. Sokal EM, Paganelli M, Wirth S, et al. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol. 2013;59:814–29.

  2. Tandon BN, Acharya SK, Tandon A. Epidemiology of hepatitis B virus infection in India. Gut. 1996;38:S56–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ni YH, Huang LM, Chang MH, et al. Two decades of universal hepatitis B vaccination in Taiwan: impact and implication for future strategies. Gastroenterology. 2007;132:1287–93.

    Article  PubMed  Google Scholar 

  4. Luo Z, Li L, Ruan B. Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period. Int J Infect Dis. 2012;16:e82–8.

    Article  PubMed  Google Scholar 

  5. Okada K, Kamiyama I, Inomata M, Imai M, Miyakawa Y. e antigen and anti-e in the serum of asymptomatic carrier mothers as indicators of positive and negative transmission of hepatitis B virus to their infants. New Engl J Med. 1976;294:746–9.

    Article  CAS  PubMed  Google Scholar 

  6. Stevens CE, Neurath RA, Beasley RP, Szmuness W. HBeAg and anti-HBe detection by radioimmunoassay: correlation with vertical transmission of hepatitis B virus in Taiwan. J Med Virol. 1979;3:237–41.

    Article  CAS  PubMed  Google Scholar 

  7. Bond WW, Favero MS, Petersen NJ, Gravelle CR, Ebert JW, Maynard JE. Survival of hepatitis B virus after drying and storage for one week. Lancet. 1981;1:550–1.

    Article  CAS  PubMed  Google Scholar 

  8. Favero MS, Bond WW, Petersen NJ, Berquist KR, Maynard JE. Detection methods for study of the stability of hepatitis B antigen on surfaces. J Infect Dis. 1974;129:210–2.

    Article  CAS  PubMed  Google Scholar 

  9. Iloeje UH, Yang HI, Su J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006;130:678–86.

    Article  PubMed  Google Scholar 

  10. Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.

    Article  CAS  PubMed  Google Scholar 

  11. Yang HI, Lu SN, Liaw YF, et al. Hepatitis B e antigen and the risk of hepatocellular carcinoma. New Engl J Med. 2002;347:168–74.

    Article  CAS  PubMed  Google Scholar 

  12. Mast EE, Margolis HS, Fiore AE, et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR recommendations and reports. Morb Mortal Wkly Rep. 2005;54:1–23.

    Google Scholar 

  13. Chen HL, Lin LH, Hu FC, et al. Effects of maternal screening and universal immunization to prevent mother-to-infant transmission of HBV. Gastroenterology. 2012;142:773–81.e2.

    Article  PubMed  Google Scholar 

  14. Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. Cochrane Database Syst Rev. 2006;2:CD004790.

    Google Scholar 

  15. Cheng KF, Chang MH, Lee CY, et al. Response to supplementary vaccination with recombinant or plasma hepatitis B vaccine in healthy non-responding children. Vaccine. 1994;12:899–902.

    Article  CAS  PubMed  Google Scholar 

  16. Lamberth JR, Reddy SC, Pan JJ, Dasher KJ. Chronic hepatitis B infection in pregnancy. World J Hepatol. 2015;7:1233–7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chen MT, Billaud JN, Sallberg M, et al. A function of the hepatitis B virus precore protein is to regulate the immune response to the core antigen. Proc Natl Acad Sci U S A. 2004;101:14913–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Milich D, Liang TJ. Exploring the biological basis of hepatitis B e antigen in hepatitis B virus infection. Hepatology. 2003;38:1075–86.

    Article  CAS  PubMed  Google Scholar 

  19. Chen CY, Ni YH, Chen HL, Lu FL, Chang MH. Lamivudine treatment in infantile fulminant hepatitis B. Pediatr Int. 2010;52:672–4.

    Article  PubMed  Google Scholar 

  20. Jindal A, Kumar M, Sarin SK. Management of acute hepatitis B and reactivation of hepatitis B. Liver Int. 2013;33:164–75.

    Article  CAS  PubMed  Google Scholar 

  21. McMahon BJ. The natural history of chronic hepatitis B virus infection. Hepatology. 2009;49:S45–55.

    Article  CAS  PubMed  Google Scholar 

  22. Bortolotti F, Guido M, Bartolacci S, et al. Chronic hepatitis B in children after e antigen seroclearance: final report of a 29-year longitudinal study. Hepatology. 2006;43:556–62.

    Article  PubMed  Google Scholar 

  23. Marx G, Martin SR, Chicoine JF, Alvarez F. Long-term follow-up of chronic hepatitis B virus infection in children of different ethnic origins. J Infect Dis. 2002;186:295–301.

    Article  PubMed  Google Scholar 

  24. Wu JF, Su YR, Chen CH, et al. Predictive effect of serial serum alanine aminotransferase levels on spontaneous HBeAg seroconversion in chronic genotype B and C HBV-infected children. J Pediatr Gastroenterol Nutr. 2012;54:97–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Roushan MR, Bijani A, Ramzaninejad S, Roushan MH, Amiri MJ, Baiani M. HBeAg seroconversion in children infected during early childhood with hepatitis B virus. J Clin Virol. 2012;55:30–3.

    Article  CAS  PubMed  Google Scholar 

  26. Chu CM, Liaw YF. HBsAg seroclearance in asymptomatic carriers of high endemic areas: appreciably high rates during a long-term follow-up. Hepatology. 2007;45:1187–92.

    Article  PubMed  Google Scholar 

  27. Iorio R, Giannattasio A, Cirillo F, D’Alessandro L, Vegnente A. Long-term outcome in children with chronic hepatitis B: a 24-year observation period. Clin Infect Dis. 2007;45:943–9.

    Article  PubMed  Google Scholar 

  28. Chang MH, Chen PJ, Chen JY, et al. Hepatitis B virus integration in hepatitis B virus-related hepatocellular carcinoma in childhood. Hepatology. 1991;13:316–20.

    Article  CAS  PubMed  Google Scholar 

  29. Giacchino R, Navone C, Facco F, Giambartolomei G, Pontisso P, Callea F. HBV-DNA-related hepatocellular carcinoma occurring in childhood. Report of three cases. Dig Dis Sci. 1991;36:1143–6.

    Article  CAS  PubMed  Google Scholar 

  30. Wen WH, Chang MH, Hsu HY, Ni YH, Chen HL. The development of hepatocellular carcinoma among prospectively followed children with chronic hepatitis B virus infection. J Pediatr. 2004;144:397–9.

    Article  PubMed  Google Scholar 

  31. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50:661–2.

    Article  PubMed  Google Scholar 

  32. Shah U, Kelly D, Chang MH, et al. Management of chronic hepatitis B in children. J Pediatr Gastroenterol Nutr. 2009;48:399–404.

    Article  PubMed  Google Scholar 

  33. European Association for the study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167–85.

    Article  Google Scholar 

  34. Jonas MM, Block JM, Haber BA, et al. Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options. Hepatology. 2010;52:2192–205.

    Article  PubMed  Google Scholar 

  35. D’Antiga L, Aw M, Atkins M, Moorat A, Vergani D, Mieli-Vergani G. Combined lamivudine/interferon-alpha treatment in “immunotolerant” children perinatally infected with hepatitis B: a pilot study. J Pediatr. 2006;148:228–33.

    Article  CAS  PubMed  Google Scholar 

  36. Poddar U, Yachha SK, Agarwal J, Krishnani N. Cure for immune-tolerant hepatitis B in children: is it an achievable target with sequential combo therapy with lamivudine and interferon? J Viral Hepat. 2013;20:311–6.

    Article  CAS  PubMed  Google Scholar 

  37. Reiss G, Keeffe EB. Hepatitis vaccination in patients with chronic liver disease. Aliment Pharmacol Ther. 2004;19:715–27.

    Article  CAS  PubMed  Google Scholar 

  38. Sethi GR, Sharma S, Sudha S, Rishi RK. Immunogenicity of recombinant hepatitis B vaccine in thallasemic children. Indian Pediatr. 1999;36:498–501.

    CAS  PubMed  Google Scholar 

  39. Zhang Y, Zhou JH, Yin XL, Wang FY. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis. World J Gastroenterol. 2010;16:770–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Mukhopadhyaya A. Hepatitis C, in India. J Biosci. 2008;33:465–73.

    Article  PubMed  Google Scholar 

  41. Yeung LT, King SM, Roberts EA. Mother-to-infant transmission of hepatitis C virus. Hepatology. 2001;34:223–9.

    Article  CAS  PubMed  Google Scholar 

  42. Mast EE, Hwang LY, Seto DS, et al. Risk factors for perinatal transmission of hepatitis C virus (HCV) and the natural history of HCV infection acquired in infancy. J Infect Dis. 2005;192:1880–9.

    Article  PubMed  Google Scholar 

  43. European Paediatric Hepatitis Virus Network. A significant sex--but not elective cesarean section--effect on mother-to-child transmission of hepatitis C virus infection. J Infect Dis. 2005;192:1872–9.

    Article  Google Scholar 

  44. Steininger C, Kundi M, Jatzko G, Kiss H, Lischka A, Holzmann H. Increased risk of mother-to-infant transmission of hepatitis C virus by intrapartum infantile exposure to maternal blood. J Infect Dis. 2003;187:345–51.

    Article  PubMed  Google Scholar 

  45. Jara P, Resti M, Hierro L, et al. Chronic hepatitis C virus infection in childhood: clinical patterns and evolution in 224 white children. Clin Infect Dis. 2003;36:275–80.

    Article  PubMed  Google Scholar 

  46. Yeung LT, To T, King SM, Roberts EA. Spontaneous clearance of childhood hepatitis C virus infection. J Viral Hepat. 2007;14:797–805.

    Article  CAS  PubMed  Google Scholar 

  47. Rerksuppaphol S, Hardikar W, Dore GJ. Long-term outcome of vertically acquired and post-transfusion hepatitis C infection in children. J Gastroenterol Hepatol. 2004;19:1357–62.

    Article  PubMed  Google Scholar 

  48. Bortolotti F, Verucchi G, Camma C, et al. Long-term course of chronic hepatitis C in children: from viral clearance to end-stage liver disease. Gastroenterology. 2008;134:1900–7.

    Article  PubMed  Google Scholar 

  49. Gonzalez-Peralta RP, Langham MR Jr, Andres JM, et al. Hepatocellular carcinoma in 2 young adolescents with chronic hepatitis C. J Pediatr Gastroenterol Nutr. 2009;48:630–5.

  50. Mack CL, Gonzalez-Peralta RP, Gupta N, et al. NASPGHAN practice guidelines: diagnosis and management of hepatitis C infection in infants, children, and adolescents. J Pediatr Gastroenterol Nutr. 2012;54:838–55.

    Article  PubMed  Google Scholar 

  51. Halfon P, Bourliere M, Ouzan D, et al. A single IL28B genotype SNP rs12979860 determination predicts treatment response in patients with chronic hepatitis C Genotype 1 virus. Eur J Gastroenterol Hepatol. 2011;23:931–5.

    Article  PubMed  Google Scholar 

  52. Schwarz KB, Gonzalez-Peralta RP, Murray KF, et al. The combination of ribavirin and peginterferon is superior to peginterferon and placebo for children and adolescents with chronic hepatitis C. Gastroenterology. 2011;140:450–8.e1.

    Article  CAS  PubMed  Google Scholar 

  53. Wirth S, Lang T, Gehring S, Gerner P. Recombinant alfa-interferon plus ribavirin therapy in children and adolescents with chronic hepatitis C. Hepatology. 2002;36:1280–4.

    Article  CAS  PubMed  Google Scholar 

  54. Wirth S, Pieper-Boustani H, Lang T, et al. Peginterferon alfa-2b plus ribavirin treatment in children and adolescents with chronic hepatitis C. Hepatology. 2005;41:1013–8.

    Article  CAS  PubMed  Google Scholar 

  55. Wirth S, Ribes-Koninckx C, Calzado MA, et al. High sustained virologic response rates in children with chronic hepatitis C receiving peginterferon alfa-2b plus ribavirin. J Hepatol. 2010;52:501–7.

    Article  CAS  PubMed  Google Scholar 

  56. Heil EL, Hynicka LM, Kottilil S, Tang L. What does the pharmacological future of treating chronic hepatitis C look like? Expert Rev Clin Pharmacol. 2015;8:605–22.

    Article  CAS  PubMed  Google Scholar 

  57. Gerlach JT, Diepolder HM, Zachoval R, et al. Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology. 2003;125:80–8.

    Article  PubMed  Google Scholar 

  58. Jaeckel E, Cornberg M, Wedemeyer H, et al. Treatment of acute hepatitis C with interferon alfa-2b. New Engl J Med. 2001;345:1452–7.

    Article  CAS  PubMed  Google Scholar 

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RM and WH wrote the document. WH reviewed and corrected the document and provided feedback and guidance to RM. WH will act as guarantor for the paper.

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Correspondence to Winita Hardikar.

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Malik, R., Hardikar, W. Hepatitis B and C in Children. Indian J Pediatr 83, 1303–1310 (2016). https://doi.org/10.1007/s12098-016-2076-4

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