Overview of hepatitis B virus infection in children and adolescents
- Annemarie Broderick, MB, BCh, MMedSc, FRCPI
Annemarie Broderick, MB, BCh, MMedSc, FRCPI
- Senior Clinical Lecturer
- University College Dublin
- Maureen M Jonas, MD
Maureen M Jonas, MD
- Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
Hepatitis B virus (HBV) infection remains a global public health problem despite the availability of an effective vaccine.
An overview of HBV infection in children will be presented here. More detailed discussions of the microbiology, pathogenesis, clinical manifestations, and diagnosis are presented separately. (See "Characteristics of the hepatitis B virus and pathogenesis of infection" and "Clinical manifestations and natural history of hepatitis B virus infection" and "Diagnosis of hepatitis B virus infection".)
In the United States, the incidence of acute hepatitis B in children (<19 years) has decreased from approximately 13.8 cases per 100,000 population (10 to 19 years) in the 1980s  to 3.03 and 0.34 cases per 100,000 population in 1990 and 2002, respectively . Declines have been greatest among children who were born after 1991 when recommendations for universal hepatitis B vaccination of infants were implemented. By 2007, the incidence of acute hepatitis B in children <15 years had fallen to 0.02 cases per 100,000 population [3,4]. (See "Hepatitis B virus vaccination".)
In the United States and in several other non-endemic countries, most cases of acute hepatitis B infection develop in patients from high-risk groups such as intravenous drug users, homosexual men, in those living in communities with a large proportion of immigrants from regions where hepatitis B virus (HBV) is endemic, and in certain groups where HBV is endemic, such as Native Americans in Alaska . The majority of children with chronic HBV infections are immigrants, have immigrant parents, or became exposed through other household contacts [6,7].
In countries where HBV is endemic, perinatal transmission remains the most important cause of chronic infection because of high rates of disease in pregnant women. Perinatal transmission also occurs in non-endemic countries, including the United States, mostly in children of HBV-infected mothers who do not receive appropriate HBV immunoprophylaxis at birth [8,9]. (See "Epidemiology, transmission, and prevention of hepatitis B virus infection" and "Clinical significance of hepatitis B virus genotypes".)
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- WHO SHOULD BE SCREENED
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- Acute HBV infection
- Chronic HBV infection
- NATURAL HISTORY
- Phases of chronic HBV infection
- - Immune tolerant
- - Immune active (clearance)
- - Inactive chronic HBV (HBeAg negative)
- - Inactive chronic HBV (loss of HBsAg)
- - HBeAg negative immune reactivation
- Progression to cirrhosis
- Hepatocellular carcinoma
- MANAGEMENT OF CHRONIC HBV
- Initial evaluation
- Counseling and prevention
- Monitoring of patients
- - Disease activity
- - HCC surveillance
- Selection of patients for treatment
- CHOICE OF TREATMENT
- Interferon alfa
- - Standard interferon
- - Pegylated interferon
- - Efficacy
- - Side effects
- - Non-responders
- Tenofovir disoproxil fumarate
- Less preferred drugs
- - Lamivudine
- - Adefovir dipivoxil
- MANAGEMENT OF ACUTE HBV
- SUMMARY AND RECOMMENDATIONS