HEPATITIS B: Clinical Perspectives in Pediatrics

Abstract

Hepatitis B virus (HBV) can cause acute and chronic liver disease in children. Age at the time of acquisition of primary HBV infection is the major determinant of chronicity, with the risk of chronic infection with HBV related inversely to the age at the time infection occurs. Perinatal transmission usually results in chronic HBV carrier status, although children are most often asymptomatic or have slow disease progression. The average time to onset of clinical liver disease following infection may range from 10 to 40 years. Many HBV carrier children, therefore, may not be brought to medical attention for appropriate counselling and anticipatory guidance in a timely fashion. Adolescence may present risk behaviors of sexual and illicit drug experimentation and alcohol use, which can additionally stress a compromised liver. Sequelae of chronic HBV infection include fulminant hepatic failure, chronic hepatitis, cirrhosis, and liver cancer. Hepatitis B is one of the major vaccine-preventable diseases of mankind. Significant progress has been seen in countries that have integrated the hepatitis B vaccination program into their Expanded Program of Immunization for children. The goal is universal vaccination for children in every country of the world. The pediatric perspective needs to emphasize an evolving continuity of care of chronic HBV hepatitis in the patient through infancy, childhood, adolescence, and adulthood. This article addresses these issues.