Challenges in the Management of Hepatitis B Among Children and Adolescents: A 10-Year Single-Center Experience

Following successful neonatal HBV vaccination and perinatal screening, pediatric hepatitis B has become uncommon in Central Europe. However, migration and complex clinical scenarios are reshaping its epidemiology. We aimed to characterize the clinical course, disease phases, and treatment eligibility of children with HBV infection. This retrospective single-center study included patients aged 0 to <18 years referred to a tertiary pediatric infectious diseases center in Warsaw, Poland, between January 2016 and June 2026. Demographic, clinical, and laboratory data were analyzed, and patients were classified according to the 2025 EASL guidelines. Sixteen children were included. New referrals tripled from 2016-2020 (n = 3) to 2021-2026 (n = 9), and 50% were refugees, predominantly from Ukraine. Vertical transmission accounted for 44% of infections, whereas 25% were iatrogenic. According to the 2025 EASL criteria, 38% (6/16) of patients were unclassifiable. Occult HBV infection was identified in 31%, while only 13% (2/16) received analogue therapy because of restrictive national treatment criteria. One adolescent developed liver fibrosis (7.6 kPa), likely related to metabolic steatohepatitis. Contemporary pediatric HBV management might require adaptation to changing epidemiology, recognition of the limitations of adult-derived disease phase classifications, and prevention of HBV reactivation during immunosuppression.