Viral Hepatitis In Children Research Articles

Intestinal microbiota in children with chronic viral hepatitis

The article is devoted to a review of the literature on the study of intestinal microbiota in chronic viral hepatitis in children. The results of recent studies of microbial diversity of colon contents using 16S ribosomal RNA sequencing are presented. Scientific research in recent years has proven the influence of changes in the microbiota and its individual representatives on the formation of complications in patients with chronic viral hepatitis, the development of fibrosis/cirrhosis. Changed quantitative and species ratios of microorganisms can lead to the launch of pathological reactions in the intestinal-liver axis system. A significant reduction in the number of bacteria such as Clostridia and Bacteroidia (Faecalibacterium, Roseburia inilinivorans, Roseburia intestinalis, Coprococcus comes) causes low production of short-chain fatty acid butyrate, which can interfere with the functioning of tight junction proteins. Leaks and increased intestinal permeability create conditions for the formation of inflammation due to the activity of pro-inflammatory cytokines. Violation of the intestinal barrier function creates the opportunity for the penetration of bacteria, lipopolysaccharide complexes, bacterial ligands and metabolites, leading to the development of immunopathological reactions. These changes in the pediatric population are less noticeable than in the adult cohort of patients, since the clinical course of chronic viral hepatitis in children has a smoother course. However, periods of exacerbation, which are characterized by clinical and laboratory changes, may maintain the risk of developing fibrogenesis activity in older age groups. Data on intestinal microbial diversity in adult patients with chronic viral hepatitis B and C are presented separately. The possibilities of using pre- and probiotic therapy in the complex treatment of chronic liver diseases in adults and children are considered.

Viral Hepatitis Necessitating Liver Transplantation in Children.

Viral hepatitis accounts for a significant global disease burden and mortality, both in children and adults. There are significant differences in the viral etiology, epidemiology, and complications in children worldwide. Children of all ages may have devastating complications with a significant risk of mortality and long-term morbidity because of viral hepatitis. Liver transplantation is the only curative option for pediatric patients with end-stage liver disease, hepatocellular carcinoma, or acute liver failure because of viral hepatitis. The introduction of universal vaccination for hepatitis B across the world and hepatitis A in some countries had led to significant changes in the incidence of disease and the need for liver transplantation for the complications of viral hepatitis in children. The development of effective treatment with directly acting antiviral agents for hepatitis C has already transformed outcomes in adults and children and reduced the need for liver transplantation. Although newer therapy for hepatitis B is being evaluated in adults, current therapy for children is not curative, indicating the need for lifelong therapy and potential necessity for liver transplantation. The recent epidemic of acute hepatitis in children across the world has highlighted the importance of understanding the etiology of unusual causes for acute liver failure and the urgent need for liver transplantation.

Clinico-epidemiological study and laboratory profile of acute viral hepatitis in children of the age group 6 months to 12 years admitted in a tertiary care hospital

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children despite the availability of vaccines, prophylactic measures and improved sanitation. The objective of the study was to determine the etiological profile of acute viral hepatitis in patients admitted in a tertiary care hospital, West Bengal, India.Methods: This prospective hospital-based study was done in, Midnapore Medical College, Paschim Medinipur, West Bengal, India from February 2020 to July 2021. Children between 6 months to 12 years who presented with fever and prodromal symptoms, with or without jaundice, abdominal pain, high coloured urine, pale coloured stools with suspicion of acute viral hepatitis were included in the study. The data were statistically analysed using Microsoft excel and statistical package for the social sciences (SPSS) software.Results: Majority of the study subjects were from Lower middle class i.e. 59.6%. Only 34.6% regularly boiled water before consuming. Majority 44.2% of the subjects had history of practicing unhealthy eating practices which included not cleaning hands before eating. 66.7% subjects did not boiled water before consumption, 33.3% were involved in unhygienic food habits and 100% were using unhygienic sanitary practices. Prevalence of hepatitis A in our study was 96.2%. and hepatitis E was 5.8%. Prevalence of HAV IgM positive was 96.2%, prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) positive was 1.9% and prevalence of HEV IgM positive was 5.8%.Conclusions: Prevalence of hepatitis A in our study was 96.2%. Hence, HAV was the most common etiological factor causing acute viral hepatitis in children. It’s important to create awareness in the society regarding preventive measures like hygienic food practices and improved sanitation which is of utmost importance in its prevention.

Non-hepatotropic viral hepatitis and its causative pathogens: The ongoing need for monitoring in children with severe acute hepatitis of unknown etiology.

Non-hepatotropic viral hepatitis and its causative pathogens: The ongoing need for monitoring in children with severe acute hepatitis of unknown etiology.

Spectrum of viral hepatitis in hospitalized children in western India.

Viral hepatitis is a major public health problem affecting children globally. Clinical presentation varies from asymptomatic illness to hepatitis, and liver failure. Data on clinical features and laboratory parameters were collected and analysed on 300 children, aged 1-12 years, admitted with confirmed viral hepatitis. A small majority (52%) were boys. The mean age of presentation was 6.9 ± 2.8 years with the commonest symptoms being anorexia or vomiting (in 98%), fever (in 89%) and jaundice (in 71.3%). Tender hepatomegaly was seen in 31.7%. Almost all (97.6%) had hepatitis A, though mixed infection (A & E) was seen in 1.7%. Only 8% had serum bilirubin levels >200 µmol/L. Significantly elevated (>20 μkat/L) levels of aspartate transaminase and alanine transaminase were seen in 19% and 25.3% of cases respectively. Coagulopathy (PT >15 s) was present in 11.0% cases. HAV remains the most common cause of viral hepatitis in children in our environment. Public awareness and universal vaccination should be the focus to prevent morbidity and mortality due to these pathogens.

Expert symposium on severe acute hepatitis of unknown cause in children, a paradigm of exchanges and sharing between Chinese and Western medicine professionals.

Expert symposium on severe acute hepatitis of unknown cause in children, a paradigm of exchanges and sharing between Chinese and Western medicine professionals.

Burden of disease and associated complications of hepatitis a in children and adults in Mexico: A retrospective database study.

BackgroundHepatitis A virus (HAV) infection is a leading cause of viral hepatitis in children, yet the HAV vaccine is not included in the national immunization program (NIP) in Mexico. This study addresses an identified evidence gap of the burden of hepatitis A disease, complications, and associated costs in Mexico by analyzing surveillance and healthcare data. Data review included disease morbidity (incidence and hospitalization), mortality, and healthcare resource utilization costs.MethodsIn this observational, retrospective database study, we conducted a systematic screening, extraction, and analysis of outcome data from the national surveillance system in Mexico from January 2000 to December 2019.ResultsDuring the analysis period (2000–2019), the average incidence rate/year of HAV cases was 14.7 (5.4–21.5) per 100,000 inhabitants. Children 1–9 years of age (YoA) had the highest average incidence rate/year with 47.8 (14.7–74.5). The average hospitalization rate/year due to HAV infection was 5.8% (2.9–9.6%). Although the highest burden of HAV continued to be in children (1–9 YoA), an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10–64 YoA) was observed. The annual average fatality rate was estimated to be 0.44% (0.26–0.83%) of which 28.8% of deaths were concentrated in adults ≥ 65 YoA. The total direct costs of medical attention due to HAV and related complications were estimated at $382 million Mexican pesos.ConclusionThe overall results suggest an uptrend in HAV infections in adolescents/adults compared to children in Mexico. Therefore, as the overall incidence risk of HAV infection decreases, the mean age of infection increases. This consequently increases the risk of severity and complications in older age groups, thus increasing the demand for healthcare resources. Our findings provide evidence for including the inactivated HAV vaccine in the Mexican NIP.

Mathematical modelling in the study of the pathogenesis of viral hepatitis in children

The aim of the work is to form a mathematical model of viral hepatitis based on structural modelling, discriminant and factorial analysis of laboratory parameters of patients. Materials and methods. The data array included the results of a comprehensive laboratory testing of 109 children with viral hepatitis B and C (33 parameters). Results. Seven main factors in the pathogenesis of viral hepatitis in children reflect the severity of endogenous intoxication and disorders of protein metabolism, modification of the mode of functioning of enzymes, and supramolecular multi-enzyme complexes in conditions of progression of the first two components. Conclusion. The identified factors of the pathogenesis of viral hepatitis may reflect the endogenous intoxication during disease progression, the state of detoxification enzyme systems, and the further fibrotic changes in the liver.

Viral hepatitis in children: state and prospects for solving the problem

The problem of viral hepatitis (VH) today is an acute problem for the world healthcare system. Along with the COVID-19 pandemic, the VH pandemic claims up to 1.5 million lives annually. Since 2016, the Russian Federation has launched a WHO program aimed at combating VH. One of the first steps on the path of global elimination is getting rid of the virus in the small groups, among which micro-elimination in the child population is one of the promising areas.This review is devoted to the current state of the problem of VH in children in the Russian Federation today. The success of vaccine prevention (against viral hepatitis A and B) made it possible to achieve results in the form of a significant decrease in the incidence of children, minimizing the risk of perinatal infection. However, in recent years, there has been a progressive decline in vaccination coverage. This is mainly due to the growing popularity of anti-vaccination lobbies, a decrease in the awareness of patients and health workers about the need for timely vaccination, as well as the introduction of restrictive measures to prevent a new coronavirus infection. The emergence of mutant, "vaccine-eluting" strains, which are also resistant to available antiviral drugs, is another serious problem on the way to eliminating viral HBV. In the field of treating children with HBV, the possibilities are extremely limited, only 2 drugs are available, one of which (tenofovir alafenamide) is available only from the age of 12. Registration of direct antiviral drugs for the treatment of adolescents with chronic hepatitis C has made it possible to bring closer the goal of microelimination of the virus in children. However, the high cost of drugs poses a challenge for the state to introduce long-term benefit programs to ensure the availability of treatment. In addition, at the moment, the treatment of young children in our country remains a prospect for the future.Thus, despite significant advances in the strategy for the elimination of viral hepatitis, a number of problems remain relevant and present significant difficulties in achieving the global goal.

915. Hepatitis A Burden of Disease and Associated Complications in Children and Adults in Mexico: A Retrospective Database Study from 2000-2019

BackgroundIn Mexico, Hepatitis A virus (HAV) infection is the leading cause of viral hepatitis in children, yet the pediatric HAV vaccine is not included in the national immunization program (NIP). Since 2013, 1-dose HAV vaccine is only given to infants of agricultural workers and in day-care centers. Mexico has intermediate HAV endemicity, yet the real burden of symptomatic HAV is unknown. The objective of this study is to describe the burden of HAV infection and severe complications in children and adults in Mexico.MethodsA retrospective database study was performed using the national surveillance system from all public health institutions in Mexico. Data on laboratory/clinically confirmed HAV cases, hospitalizations, and deaths, including for severe complications (Fulminant Hepatic Failure, Acute Liver Failure, Liver transplant), from 2000 to 2019 were analyzed (Table 1). Descriptive analyses were performed to estimate the disease burden and direct medical costs due to HAV per year for all ages, sex, and region. Table 1. Definition HAV-associated disease based on ICD-10 codes HAV, Hepatitis A Virus; ICD-10, International Classification of Diseases 10 Classification SystemResultsDuring the analysis period, the average annual incidence was 29.4 per 100,000 population (range: 43.0–10.9); the average hospitalization rate/year was 5.8% (range: 2.9%– 9.6%); and the average fatality rate/year was 0.44% (range: 0.23%–0.83%) (Figures 1a-b). Overall, there was a decreasing trend in HAV incidence over 2000–2017, with a recent increase in 2017–2019. As the incidence risk of HAV infection decreased, the mean age of infection increased. The biggest burden of HAV continued to be in children (1–9 years-old), yet there was an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10–64 years-old) (Figures 2-3). The total direct medical costs (2019) due to HAV and related complications was estimated at &3.8 million Mexican pesos, which represented about 0.063% of total 2019 expenditure of the federal public budget for the health function. Figure 1. (a) Hospitalization rate (%) due to HAV infection by year in Mexico. (b) Fatality rate (%) due to HAV infection by year in Mexico. HAV, Hepatitis A Virus Figure 2. Incidence of HAV cases by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age Figure 3. Hospitalizations due to HAV infection and complications by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age ConclusionIn addition to Mexico’s intermediate HAV endemicity and improved sanitary conditions, these results describe an increase of HAV infection from children to adolescents/adults, which increases the risk for more severe and complicated disease and greater demand on healthcare resources. Our findings support the evidence for HAV vaccine inclusion in the NIP in Mexico.Disclosures Gerardo Luna-Casas, MD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Gilberto Sanchez-Gonzalez, PhD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Maria Yolanda Cervantes Apolinar, MD, The GSK Group of Companies (Employee, Shareholder) Gloria Huerta, MD, The GSK Group of Companies (Employee, Shareholder) Adriana Guzman Holst, MPH, The GSK Group of Companies (Employee)

Цитомегаловірусний гепатит у дітей

У статті надано аналіз структури вірусних гепатитів у дітей, серед яких цитомегаловірусний (ЦМВ) гепатит як моноінфекція діагностовано у 8 (3,4 %) дітей, мікст-інфекція — у 10 (4,3 %) хворих. Представлені клінічні спостереження ЦМВ-гепатиту у дітей різного віку, що демонструють різні варіанти перебігу: гострий ЦМВ-гепатит, який закінчився одужанням у 12-річної дитини, і первинно-хронічний у 5-місячної дитини.

Clinical Profile of Acute Viral Hepatitis in Children – In Southern Assam

Clinical Profile of Acute Viral Hepatitis in Children – In Southern Assam

Progress in diagnosis and treatment of viral hepatitis in children

Hepatitis B and C virus infections are major global public health problem and economic burden. Most children with vertical infection have asymptomatic hepatitis, but the risk of chronic viral hepatitis and further development of liver cirrhosis or hepatocellular carcinoma is higher. Over the past two to three decades, with the rapid development of detection technology and the continuous research and development of antiviral drugs, great progress has been made in the diagnosis and treatment of viral hepatitis caused by hepatitis B and C infection. However, due to the particularity of its characteristics, it is still necessary to carefully judge and evaluate the diagnosis and antiviral treatment of children. This article focuses on the difficulties in the diagnosis and treatment of viral hepatitis in children, and summarizes its progress.

Unusual cardiac manifestation of Hepatitis A virus infection in children – A case report

Hepatitis A virus infection is one of the major causes for acute viral hepatitis in children. Many extra-hepatic manifestations have been described in the literature. Only three cases of cardiovascular involvement in Hepatitis A in children have been reported till now. We here report two pediatric case of Hepatitis A infection with bradycardia.

Maternal infections with an increased risk of transmission to the foetus; a literature review

Screening testing for infectious diseases with vertical transmission, from mother to foetus, decreases the prevalence of foetal malformations. The most common infections with teratogenic potential are found in the TORCH test (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex virus). Early identification of these pathogens results in better neonatal outcomes. Most foetuses with congenital toxoplasmosis are asymptomatic or have no apparent birth defect, while the primary infection of pregnancy with varicella-zoster virus (VZV) can lead to congenital foetal abnormalities with devastating consequences. Treponema pallidum can easily infect the placenta, with transplacental transmission to the foetus that can occur from about 9-10 weeks of gestation. Also, hepatitis B and C are the most common causes of chronic viral hepatitis in children and adults. In the case of HIV-positive pregnant women, the early association of ART, together with the choice of birth by scheduled caesarean section and the complete lack of breastfeeding determine expected neonatal results, the risk of vertical transmission decreasing up to 1-2%. Primary rubella infection during pregnancy can significantly affect foetal development, as does Herpes simplex virus (HSV) infection, but if it occurs as close as possible to birth, the disease may be self-limiting with mild forms. No teratogenic agent should be described qualitatively, as a teratogenic exposure includes not only the agent but also the dose and time of pregnancy when the exposure will occur. Screening tests are recommended to be performed both preconceptionally and during pregnancy.

Acute viral hepatitis in children: a prospective hospital based study

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children despite the availability of vaccines, prophylactic measures and improved sanitation. The objective of the study was to analyze the etiology, clinical features, laboratory parameters and sonological findings of Acute Viral Hepatitis in pediatric population.Methods: A total of 88 children admitted in paediatric department and gastroenterology unit of medicine department with confirmed acute viral hepatitis from June 2016 to July 2018 at tertiary health care teaching hospital of north India were included. The patients were divided in 3 age groups; 1-5, 6-10 and 11-18 years. Clinical features, laboratory parameters, ultrasound findings were compared in three age groups.Results: Out of 88 cases 48 were boys and 40 girls. In the present study hepatitis A was the most common (85.2%) etiology. Jaundice (90.9%) is the most common symptoms followed by dark colored urine (86.3%), loss of appetite (83.3%) and fever (68.2%) reported in this study. Icterus (90%) is the most common sign reported followed by hepatomegaly (86%). Out of 88 cases 4 cases died. Out of 4 deaths, 2 cases of hepatitis A and 2 cases positive for Hepatitis B. The cause of death was hepatic encephalopathy in both the cases.Conclusions: Majority of cases in children were hepatitis A cases. Most of the cases were aged above 5 years with slight male predominance. Those cases with elevated liver enzymes (SGOT >5000) and those with PT INR >3.5 at admission has higher mortality.

HEPATITIS E: A RARE CAUSE OF IMMUNE THROMBOCYTOPENIC PURPURA

Acute viral hepatitis in children usually is a self-limiting mild disease which does not require any specific treatment. It is most commonly caused by hepatotropic viruses, hepatitis A and hepatitis E virus spread by the feco-oral route. Hepatitis E infection mostly follows an asymptomatic and anicteric course in the younger age group than icteric hepatitis. Rarely, they cause cholestatic hepatitis and fulminant hepatitis. It may rarely be associated with various extra-hepatic autoimmune manifestations. We herein report an extremely rare case of immune thrombocytopenia in a young girl associated with acute hepatitis E infection, who had an uneventful course on conservative management. She presented to us with nausea, vomiting, lethargy, jaundice, and petechial spots. On examination and investigating further, the patient had features of immune thrombocytopenic purpura and positive serology for IgM hepatitis E, whereas, a workup for other causes was normal.

The changing epidemiology of hepatitis B and C infections in Nanoro, rural Burkina Faso: a random sampling survey

BackgroundThis study sought to provide up-to-date hepatitis B (HBV) and C (HCV) seroprevalence in rural Burkina Faso decade after hepatitis B vaccine was introduced in the national immunization scheduled for children.MethodsIn 2018, a community-based, random sampling strategy with probability proportional to population size was conducted in Nanoro to investigate the prevalence of viral hepatitis in children and their mothers. Sociodemographic, vaccination history and risk factors were assessed by interview and health books. HBsAg rapid tests were done by finger prick and Dried Blood Spots (DBS) were collected for hepatitis seromarkers by chemiluminescence enzyme immunoassay. Positive samples underwent confirmatory PCR and phylogenetic analysis.ResultsData were presented on 240 mother-child pairs. HBsAg Prevalence was 0.8% in children and 6.3% in mothers. Hepatitis B core antibody positivity was 89.2% in mothers, 59.2% in children and was associated with age, sex and scarification. Hepatitis B surface antibodies prevalence was 37.5% in children and 5.8% in mothers. Good vaccination coverage was limited by home delivery. Phylogenetic analysis of HBV strains based on full genome sequences (n = 7) and s-fragment sequences (n = 6) revealed genotype A, E, and recombinant A3/E. Viral genome homology was reported in one mother-child pair. Anti-HCV prevalence was 5.4% in mothers, 2.1% in children and strains belonged to genotype 2.ConclusionsIn Nanoro, HBsAg prevalence was low in children, intermediate in mothers and mother-to-child transmission persists. Home delivery was a limiting factor of Hepatitis B vaccination coverage. HBV genotype E was predominant and genotype A3/E is reported for the first time in Burkina Faso.

Viral hepatitis.

Hepatitis viruses A to E can cause abnormal liver function tests in children. Although, overall, they are relatively uncommon in children in Australia, epidemiology diagnosis and treatment modalities for these viruses have evolved over the last decade. This review provides an update on the diagnosis and treatment of viral hepatitis in children.

A clinical study of viral hepatitis in children: a prospective hospital-based study

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children; Clinical presentation may vary from asymptomatic to hepatitis, cirrhosis, liver failure and cancer. This study is aimed at understanding the clinical profile of viral hepatitis in children.Methods: Prospectively, 48 children admitted in paediatric unit with confirmed viral hepatitis from August 2015 to July 2016 at KIMS hospital, Bangalore were included. In each case, age, sex, clinical presentation and laboratory investigations were collected and analysed.Results: Out of 48 patients, 26 were girls and 22 were boys. Out of which 40 cases were positive for IgM Hepatitis A, 1 case of HbsAg positive, 7 cases were non-A non B Hepatitis. All cases presented with fever (100%), jaundice found in 40 cases (83.3%), 33 cases had abdominal pain (68.7%), vomiting was present in 40 cases (83.7%), 34 cases presented with dark colored urine (70.8%), altered sensorium in 3 cases (6.2%). Icterus was found in 48 (100%) cases, pallor was found in 17 cases (35.4%), Ascitis in 8 cases (16.7%), hepatomegaly in 37 cases (76%), oedema in 10 cases (21%). Liver enzymes elevated at admission in almost all cases, 16 cases had SGPT b/w 200-500. 10 cases had SGPT b/w 500-1000, 19 cases had SGPT b/w 1000-3000 and 2 cases had SGPT of more than 3000. 18 cases had total bilirubin between 5-10 mg/dl, 6 cases had total bilirubin >10 mg/dl. 44 cases had PT <1.5 at admission, 1 case had PT INR between 1.5-2.5, 1 case had INR between 2.5-3.5, 2 cases had INR>3.5. Out of 48 cases 2 cases died. Out of 2 deaths, 1 case of hepatitis A and 1 case positive for Hepatitis B. The cause of death was hepatic encephalopathy in both the cases.Conclusions: Majority of cases in children were hepatitis A cases, followed by non-A non B. Most of the cases were aged above 3 years with slight girl’s predominance. Those cases with elevated liver enzymes (SGOT >3000) and those with PT INR >3 at admission has higher mortality.