Unrecognized hepatitis B in pre-screened children with hematologic and oncologic conditions
Daniel H Leung1, David C Ahamba, Lekshmi N Pillai
1Baylor College of Medicine, Pediatrics, Houston, Texas; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, Texas.
Insights
Hepatitis B (HBV) screening in children with cancer or blood disorders often lacks confirmatory DNA testing, increasing reactivation risk. Routine HBV DNA testing is crucial for identifying chronic infections and enabling timely treatment.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Hepatitis B virus (HBV) screening is vital for at-risk pediatric populations.
- Children with cancer or blood disorders represent a high-risk group for HBV infection.
- Effectiveness of current HBV screening protocols in this cohort requires evaluation.
Purpose of the Study:
- To assess the effectiveness and interpretation of hepatitis B virus (HBV) screening in pediatric patients with cancer or blood disorders.
- To analyze serological results and clinical outcomes following positive HBV screening.
- To identify gaps in follow-up testing and potential risks for HBV reactivation.
Main Methods:
- Retrospective analysis of HBV screening data (HBsAg, HBcAb) from 1999-2009.
- Inclusion of pediatric patients with hematologic and oncologic conditions.
- Analysis of demographics, serologies, and clinical outcomes, including HBV DNA testing and diagnosis.
Main Results:
- 12,754 children screened; 391 tested positive for HBV.
- 118 of positive cases had hematologic/oncologic diagnoses (leukemia, anemia, thrombocytopenia).
- 98% tested positive for HBcAb, but only 20% received HBV DNA testing; 13% of those tested had chronic HBV.
Conclusions:
- A significant majority of children with cancer/blood disorders who screened positive for HBV did not undergo confirmatory DNA testing.
- Lack of DNA testing poses a risk of HBV reactivation and delays treatment initiation.
- Routine HBV DNA confirmation is recommended for accurate diagnosis and management of chronic HBV infection in this vulnerable population.
Background:
This study evaluates the effectiveness and interpretation of hepatitis B (HBV) screening in an at-risk cohort of children with cancer or blood disorders.
Procedure:
We conducted a retrospective epidemiologic analysis of children who screened positive for HBV (HBsAg, HbcAb) from 1999 to 2009 at a quaternary children's hospital, focusing on patients with hematologic and oncologic conditions. Descriptive statistics were generated for demographics and serologies. Follow-up of positive serologies and clinical outcomes were analyzed.
Results:
A total of 12,754 children were screened for HBV. Of 391 that screened positive, 118 had a hematologic or oncologic diagnosis. Leukemia, anemia, and thrombocytopenia comprised 84% of diagnoses. The majority (98%) tested HBcAb positive but only 20% received confirmatory HBV DNA testing. Three patients (13% of those HBV DNA tested) were identified to have chronic disease. HBV was not a known pre-existing condition, and chemotherapy preceded HBV diagnosis in all cases.
Conclusions:
The majority of children with cancer or blood disorders who screened HBV positive did not receive follow-up DNA testing, exposing them to reactivation risk and delaying definitive therapy. HBcAb may be the only indicator of chronic HBV infection and DNA confirmation should be routine. Our findings suggest a significant number of additional patients eligible for HBV treatment may have been identified with reflexive DNA testing.
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