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Acute infectious hepatitis in hospitalised children: a British Paediatric Surveillance Unit study
Serena Braccio1,2, Adam Irwin1, Andrew Riordan3
1Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
Insights
Hepatitis A virus (HAV) and hepatitis B virus (HBV) are key causes of viral hepatitis in children. While most children recover from HAV, acute HBV can lead to severe liver issues, highlighting the importance of vaccination.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Public Health Virology
Background:
- Hepatitis remains a significant global public health concern, with viral infections being the primary cause in children.
- Hepatitis A virus (HAV) and hepatitis B virus (HBV) are particularly prevalent in pediatric populations.
- Understanding the burden and clinical spectrum of acute infectious hepatitis in hospitalized children is crucial for effective public health strategies.
Purpose of the Study:
- To estimate the incidence and burden of acute infectious hepatitis among hospitalized children in the UK and Ireland.
- To characterize the clinical presentations, risk factors, and outcomes of pediatric hepatitis cases.
- To identify potential areas for prevention, particularly concerning vaccination strategies.
Main Methods:
- A prospective surveillance study was conducted through the British Paediatric Surveillance Unit (BPSU), collecting data from pediatricians on children aged 1 month to 14 years diagnosed between January 2014 and January 2015.
- Additional cases of HAV and HBV in England and Wales were identified using the national electronic database, LabBase2.
- Confirmed cases were followed up at 6 months using a second questionnaire to assess outcomes.
Main Results:
- The BPSU survey identified 69 cases, with an annual incidence of 0.52 per 100,000 children. Hepatitis A virus (HAV) accounted for 39% of cases, hepatitis B virus (HBV) for 4%, other viruses for 23%, and 33% had an unidentified etiology.
- LabBase2 identified an additional 10 HAV and 2 HBV cases. Among hospitalized HAV cases, 70% had traveled abroad, and only 8% were vaccinated.
- Of the five acute HBV cases, three were not immunized despite close contact with an infectious individual. While all HAV patients recovered fully, three HBV patients developed liver failure, and two required liver transplantation.
Conclusions:
- Acute infectious hepatitis is an uncommon reason for pediatric hospital admission.
- While most children recover from viral hepatitis without complications, acute HBV infections can present severely.
- Vaccination, especially for household contacts of HBV-infected individuals, is critical for preventing severe outcomes and potential liver failure.
Background:
Hepatitis remains a key public health priority globally. Most childhood cases are caused by viruses, especially hepatitis A virus (HAV) and hepatitis B virus (HBV). This study aimed to estimate the burden of acute infectious hepatitis in hospitalised children and to describe their clinical characteristics and outcomes.
Methods:
Paediatricians in the UK and Ireland reported cases in children aged 1 month to 14 years diagnosed between January 2014 and January 2015 (inclusive) through the British Paediatric Surveillance Unit (BPSU) and completed a detailed questionnaire. Additional HAV and HBV cases in England and Wales were identified through a national electronic database, LabBase2. All confirmed cases were followed up at 6 months with a second questionnaire.
Results:
The BPSU survey identified 69 children (annual incidence, 0.52/100 000), including 27 HAV (39%), three HBV (4%), 16 other viruses (23%) and 23 with no aetiology identified (33%). LabBase2 identified an additional 10 HAV and 2 HBV cases in England. Of the 37 hospitalised HAV cases, 70% had travelled abroad, but only 8% had been vaccinated. Similarly, three of the five children with acute HBV had not been immunised, despite being a household contact of a known infectious individual. All patients with HAV recovered uneventfully. In contrast, three children with acute HBV developed liver failure and two required liver transplantation.
Conclusions:
Acute infectious hepatitis is a rare cause of hospital admission. Most children recovered without complications, but those with acute HBV had severe presentations. At least three of the five HBV cases could have been prevented through appopriate vaccination of household contacts.
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