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Chronic Hepatitis B in Children - A Review
1Dr Md Rukunuzzaman, Associate Professor, Department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh;
Insights
Hepatitis B Virus (HBV) infection affects millions in Bangladesh, primarily children. Prevention through vaccination and immunoprophylaxis is crucial due to complex treatment and high costs.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Hepatitis B Virus (HBV) infection is a global health concern, with Bangladesh experiencing a 3% prevalence, largely driven by childhood infections.
- Chronic HBV infection presents complex management challenges, particularly in pediatric populations, due to asymptomatic phases and limited treatment options.
Purpose of the Study:
- To review the epidemiology and management of chronic Hepatitis B Virus (HBV) infection in Bangladesh.
- To emphasize the importance of prevention strategies like vaccination and immunoprophylaxis in resource-limited settings.
Main Methods:
- Literature review of HBV prevalence, transmission, and treatment guidelines.
- Analysis of treatment efficacy and cost-effectiveness in the context of Bangladesh.
Main Results:
- Chronic HBV infection affects approximately 10 million people in Bangladesh, with perinatal transmission being significant in Southeast Asia.
- Current treatments for chronic HBV are expensive, with limited success rates (17-32% for nucleosides, 58% for interferon), making them unsuitable for the general population.
- Vaccination and immunoprophylaxis are identified as the most effective and rational prevention strategies for HBV in Bangladesh.
Conclusions:
- Given the challenges in treating chronic HBV infection and the high cost of therapies, prevention is paramount in Bangladesh.
- Universal HBV vaccination, initiated in 2004, and immunoprophylaxis for infants of HBsAg-positive mothers are critical public health interventions.
Abstract:
Hepatitis B Virus (HBV) infection is prevalent worldwide. The prevalence is lowest (0.2-0.5%) in countries having high standard of living. About 10 million people are chronically infected with HBV in Bangladesh and it is possible that most infections occur during childhood. Overall prevalence is about 3% in Bangladesh. Perinatal transmission is more common in hyper-endemic areas of South East Asia. Chronic hepatitis B infection evolves through five phases. Most of the children belong to immune tolerant phase. About 57% patients of chronic hepatitis B are asymptomatic. Treatment of chronic hepatitis B is difficult. Decision regarding when, whom and how to treat in children is complex. Moreover, there are only limited drugs that can be used in treating chronic hepatitis B in children. Goal of therapy are to reduce viral replication, to minimize liver injury, to reduce consequence of liver injury like cirrhosis, hepatocellular carcinoma and to reduce infectivity of HBV. Treatment should be considered in chronic hepatitis B if patient have persistently elevated ALT of more than twice normal and evidence of viral replication. There are some special circumstances where treatment of chronic hepatitis B can be given in absence of standard criteria. These conditions are cirrhosis, chemotherapy, immunosuppression, presence of co-infection (HBV-HIV), family history of HCC and pregnant women with high viral load. Sero-conversion occurs in about 17-32% cases if treated with oral nucleot(s)ide analogue and in about 58% cases if treated with interferon. These expensive drugs with limited treatment success are not suitable for the people of Bangladesh. Therefore, risk factors identification and prevention of HBV infection is the logical and rational approach for a country like Bangladesh. Vaccination against HBV play central role in preventing infection. HBV vaccine has been incorporated in EPI schedule since 2004 in Bangladesh. Immunoprophylaxis of babies of HBsAg positive mother and post exposure prophylaxis are effective ways of prevention.
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