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Hepatitis B and C in children

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 311–320 (2008)Cite this article

Abstract

Chronic infection with hepatitis B affects nearly 350 million individuals worldwide and is the leading cause of hepatocellular carcinoma and liver cirrhosis. Universal infant immunization has decreased rates of HBV infection, although transmission continues to occur via vertical (mother-to-child) and horizontal (sexual, parenteral and household) routes. Treatments are now available for children with chronic HBV infection, but appropriate selection of those most likely to respond to treatment is important. Interferon α and lamivudine are currently approved in the US for the treatment of children older than 2 years of age who have chronic HBV infection. Hepatitis C infection affects almost 170 million individuals worldwide. Of individuals exposed to HCV, 60–80% develop chronic hepatitis, and 10–15% of those chronically infected develop cirrhosis within several decades. No vaccine exists for HCV; therefore, prevention of parenteral transmission is important. A high index of suspicion is essential for the diagnosis of HCV infection given its silent clinical presentation. Appropriate evaluation of infected individuals is warranted when considering their suitability for therapy. Interferon α and ribavirin, used in combination, are currently approved in the US for the treatment of children older than 3 years of age with chronic HCV infection.

Key Points

  • The implementation of universal infant hepatitis B immunization has reduced vertical transmission rates by 85–90%, and has similarly reduced the rates of hepatocellular carcinoma due to hepatitis B

  • Without prophylaxis, neonates exposed to HBV have a greater than 90% risk of developing chronic infection, in comparison to adults, who, when exposed, only have a 2–10% risk of developing chronic infection

  • Determination of active viral infection and associated hepatocellular inflammation is important when considering antiviral therapy for patients with chronic hepatitis B

  • HCV infection usually occurs without symptoms, and most infected individuals develop chronic infection

  • HCV genotype is important in the prediction of treatment response to antiviral therapy

  • Liver biopsy is imperative to determine the degree of hepatocellular injury from chronic hepatitis C

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Figure 1: One possible evaluation algorithm for children with chronic HBV infection.
Figure 2: One possible screening and evaluation algorithm for children with chronic HCV infection.

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Authors and Affiliations

  1. Division of Gastroenterology and Nutrition, EK Hsu is a first year Fellow in Pediatric Gastroenterology at The Children's Hospital of Philadelphia, Philadelphia, PA, and KF Murray is Director of the Hepatobiliary Program, Children's Hospital and Regional Medical Center, Seattle, WA, USA.,

    Evelyn K Hsu & Karen F Murray

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  1. Evelyn K Hsu
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Correspondence to Karen F Murray.

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Competing interests

Karen F Murray has received grant/research support from Gilead, Roche and Schering-Plough. Evelyn K Hsu declared no competing interests.

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Hsu, E., Murray, K. Hepatitis B and C in children. Nat Rev Gastroenterol Hepatol 5, 311–320 (2008). https://doi.org/10.1038/ncpgasthep1124

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