Viral Hepatitis B: Management in Children

The natural history of chronic hepatitis B virus (HBV) infection in children varies with age at infection, acquisition, ethnicity, and endemic region. Around the world, most chronic hepatitis B virus (HBV) infection is transmitted perinatally or during early childhood. The risk of chronic infection when acquired in infancy is 90% versus 30% when acquired during the first 5 years of life and <5% in older childhood and adulthood (McMahon BJ, Alward WL, Hall DB, Heyward WL, Bender TR, Francis DP, Maynard JE. J Infect Dis 151:599–603, 1985). Loss of hepatitis B e antigen (HBeAg) or seroconversion to anti-HBe can occur spontaneously, and the annual rate differs by age (<2% in children <3 years, 4–5% after age 3), with higher rates during puberty (Chang MH, Sung JL, Lee CY, Chen CJ, Chen JS, Hsu HY et al. J Pediatr 115(3):385–390, 1989; Liaw YF, Chu CM, Lin DY, Sheen IS, Yang CY, Huang MJ. J Med Virol 13(4):385–391, 1984). Children from non-endemic areas are less likely to have been perinatally infected and will often undergo HBeAg seroconversion in the first two to three decades of life (Bortolotti F, Cadrobbi P, Crivellaro C, Guido M, Rugge M, Noventa F et al. Gastroenterology 99:805–810, 1990).