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[Special problems of virus hepatitis B in pediatrics (author's transl)]
Insights
Infants are less likely to contract hepatitis B virus (HBV) but often develop chronic infections. Vertical transmission from mothers to newborns poses an 80% infection risk, necessitating immediate immune prophylaxis for infants born to HBs-Ag-positive mothers.
Area of Science:
- Hepatology
- Virology
- Immunology
Context:
- Hepatitis B virus (HBV) infection is less common in children than adults.
- Childhood HBV infections often present as subclinical or chronic, with impaired cellular immune responses.
- Neonatal HBV infection occurs frequently via vertical transmission from HBs-Ag-positive mothers.
Purpose:
- To highlight the distinct clinical course and transmission dynamics of HBV in pediatric populations.
- To emphasize the high risk of vertical transmission and lifelong carrier status in neonates.
- To underscore the critical need for timely immune prophylaxis in at-risk newborns.
Summary:
- Infants and children exhibit a higher propensity for subclinical and chronic courses of hepatitis B.
- Vertical transmission during the third trimester or delivery results in an 80% infection rate for newborns.
- Neonatal hepatitis B infection, particularly from high-titer HBs-Ag-positive mothers, can lead to fulminant, lethal outcomes.
- Immediate immune prophylaxis with anti-HBs immunoglobulin is crucial for newborns of HBs-Ag-positive mothers.
Impact:
- Informs pediatricians and obstetricians about the risks of neonatal hepatitis B.
- Stresses the importance of screening pregnant women for HBs-Ag.
- Advocates for prompt post-exposure prophylaxis in neonates to prevent chronic HBV infection and its sequelae.
Abstract:
Virus hepatitis B occurs less frequently in infants and children than in adults; a subclinical and chronic course of this disease however seems to occur more often in childhood. Especially after oral infection the growing organism does not seem to be capable of building up a cellular immune response sufficient to eliminate the virus. If a woman becomes infected with hepatitis B during the last trimester of pregnancy of or immediately before delivery, the newborn has a chance of 80% to become infected during birth himself. This so called vertical transmission may be compared to a large transfusion of HBs-Ag-positive blood. Infection of the neonates will lead in most cases to a probably life-long HBs-Ag-carrier status. A fulminant, that is to say lethal course of acute hepatitis B in early infancy was found mostly in cases, where the mothers were carriers of high titer HBs-Ag without clinical symptoms whatsoever. For that reason immediate immune prophylaxis with anti HBs-globuline is mandatory in newborns with neonatal hepatitis B infection, whose mothers are HBs-Ag-positive.