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Chronic viral hepatitis
1Department of Pediatrics, College of Medicine, National Taiwan University, Taipei.
Insights
Hepatitis B virus (HBV) is a major cause of chronic hepatitis, primarily transmitted perinatally or through unsafe injections. Immunoprophylaxis at birth is key to preventing HBV and hepatitis D virus (HDV) infections.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B, C, and D viruses can lead to chronic hepatitis in children and adults.
- Hepatitis B virus (HBV) infection is the most common and significant, with perinatal transmission being a major factor in hyperendemic regions.
- Horizontal transmission via non-sterile needles and intrafamilial spread also contribute significantly to chronic HBV carriers.
Purpose of the Study:
- To summarize the transmission routes and natural course of chronic hepatitis B, C, and D infections.
- To highlight the importance of immunoprophylaxis for preventing HBV and HDV.
- To discuss current strategies and future needs for preventing hepatitis C virus (HCV) infection in children.
Main Methods:
- Review of existing literature on hepatitis virus transmission and prevention.
- Analysis of epidemiological data regarding perinatal and horizontal transmission of HBV.
- Discussion of immunoprophylaxis efficacy and vaccination research for HCV.
Main Results:
- Perinatal transmission accounts for 40-45% of chronic HBV infections in hyperendemic areas.
- Host immune response leads to HBV and hepatitis B e antigen (HBeAg) clearance, often accompanied by liver damage.
- Blood product screening has reduced post-transfusion HCV infections, but vaccination for sporadic cases is still under development.
Conclusions:
- Immunoprophylaxis initiated at birth is the most effective strategy for eliminating HBV and preventing HDV infections.
- HCV infection in children is primarily associated with high-risk exposures, including blood products and maternal viremia.
- Development of an effective HCV vaccine is crucial for preventing sporadic infections.
Abstract:
Among hepatitis A to E viruses, hepatitis B, C, and D viruses can cause chronic hepatitis, in both children and adults. Hepatitis B virus (HBV) infection is the most prevalent and important one. Perinatal transmission accounts for about 40-45% of chronic HBV infection in hyperendemic areas. Horizontal transmission through intramuscular injection using non-sterile needles and intrafamilial spread accounts for the other half of carriers. During the natural course of HBV infection, the host gradually clears HBV and hepatitis B e antigen (HBeAg), liver damage and elevation of aminotransferases occur during the process of HBV clearance. The most effective way to eliminate HBV infection is immunoprophylaxis starting since birth. It can prevent both HBV and hepatitis D virus (HDV) infections. Hepatitis C virus (HCV) infection in children occurs mainly in high risk children, such as those who received blood product or injection using non-sterile needles, or infants of HCV viremic mothers, etc. Screening of blood product reduced markedly the prevalence of post-transfusion HCV infection, but the prevention of sporadic cases requires HCV vaccination which is still under investigation.