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Hepatitis E in Children: A Position Paper by the ESPGHAN Hepatology Committee
Björn Fischler1, Ulrich Baumann, Antal Dezsofi
1*Department of Paediatrics, CLINTEC, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden †Division of Paediatric Gastroenterology and Hepatology, Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany ‡First Department of Paediatrics, Semmelweis University, Budapest, Hungary §Paediatric Centre for Hepatology, Gastroenterology and Nutrition, King's College Hospital, London, UK ||Paediatric Hepatology Service, Hospital Infantil Universitario "La Paz," Madrid, Spain ¶Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria #Paediatric Gastroenterology Unit, Department of Pediatrics, University Hospitals Geneva, Switzerland **Hepatometabolic Unit, Bambino Gesu Children's Hospital, Rome, Italy ††Pediatric Gastroenterology and Hepatology Unit, IREC, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium ‡‡Department of Paediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands §§Pediatric Hepatology Unit, Hôpital NECKER-APHP, Paris, France.
Background:
Hepatitis E virus (HEV) is endemic in large parts of the developing world. Waterborne transmission of genotypes 1 or 2 commonly causes acute hepatitis, which is usually self-limited in healthy individuals. In addition, acute HEV infections also occur outside endemic areas, mostly related to foodborne transmission of HEV genotype 3. A growing number of publications in the last decade have reported chronic infection progressing to cirrhosis in immunosuppressed patients. It has also been suggested that HEV transmission may occur via contaminated blood products. This publication aims to provide recommendations for diagnosis, prevention, and treatment of HEV infection, particularly in children after solid organ transplantation.
Methods:
A systematic PubMed literature search on HEV infection from 1990 to January 2016 was performed focusing on pediatric studies. The existing body of evidence was reviewed and recommendations were agreed upon following discussion and unanimous agreement by all members of the ESPGHAN Hepatology Committee during a consensus meeting in January 2016. In the absence of randomized controlled studies these recommendations were considered to be expert opinions.
Key Recommendations:
Immunocompetent children with increased transaminases and/or extrahepatic manifestations should be considered for testing for evidence of HEV infection. Immunocompromised children with increased aminotransferases should be repeatedly tested for HEV and may require therapeutic intervention.
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