Infantile hepatitis B in immunized children: risk for fulminant hepatitis and long-term outcomes.
Resource
PLoS One, 9(11),
Date Issued
2014-11
Author(s)
Tseng, Yu-Ru
Tseng, Yu-Ru
JIA-FENG WU
Wu, Jia-Feng
Wu, Jia-Feng
Yen-Hsuan Ni
Kong, Man-Shan
Yeung, Chun-Yan
Huang, Fu-Chen
Chang, Shan-Chwen
Huang, Fu-Chen
Huang, I-Fei
Huang, I-Fei
Ni, Yen-Hsuan
Ni, Yen-Hsuan
Hsu, Hong-Yuan
Hsu, Hong-Yuan
Chang, Mei-Hwei
Chen, Huey-Ling
Chen, Huey-Ling
Abstract
Background: Infantile hepatitis B after neonatal immunoprophylaxis is a rare yet distinct disease. This study aimed to analyze the long-term outcomes and risk factors in immunized infants with hepatitis B.Methods: The clinical parameters and outcomes of 41 infants born after universal immunization, and admitted for HBVpositive hepatitis were studied. All patients were followed for at least 6 months (median = 4.4 years, range 0.6-18.1 years). Patient survival, changes of HBsAg and HBeAg status, and complications were analyzed.Results: Among the 41 cases (32 males, 9 females), 21 presented with fulminant hepatitis (FH), and 20 with non-fulminant hepatitis (NFH). Ninety-five percent (36/38) of the mothers were positive for hepatitis B surface antigen (HBsAg). Multivariate analyses revealed younger age of onset (age <7 months) and negative maternal hepatitis B e antigen (HBeAg) were associated with FH (p = 0.03 and p = 0.01, respectively). An infantile fulminant hepatitis B risk score using maternal/infant HBeAg positivity and onset age was proposed. Among the FH cases, the rate of mortality, HBsAg clearance, and chronic HBV infection were 47.6%, 38.1%, and 14.3%, respectively. Among the NFH cases, 35% developed chronic infection. Of the 9 chronically infected children received long-term follow-up, 8 had HBeAg seroconversion before 4 years of age. One case of FH developed hepatocellular carcinoma 14 years later.Conclusions: Maternal HBsAg +/HBeAg- and early onset age were risk factors for FH in immunized infants. A significant portion of patients with FH or NFH evolve to chronic HBV infection, with HBeAg seroconversion in young childhood. Close surveillance for hepatocellular carcinoma is warranted in patients surviving infantile hepatitis B. ? 2014 PLOS ONE.
SDGs
Other Subjects
alanine aminotransferase; bilirubin; hepatitis B antibody; hepatitis B surface antigen; hepatitis B vaccine; hepatitis B(e) antigen; lamivudine; alanine aminotransferase blood level; Article; bilirubin blood level; child; chronic hepatitis; clearance; clinical article; controlled study; disease severity; female; follow up; hepatitis B; human; IFHB score; immunization; infant; infant mortality; infection risk; liver cell carcinoma; male; onset age; retrospective study; scoring system; seroconversion; survival; Taiwan; adolescent; complication; hepatitis B; liver cell carcinoma; liver tumor; mother; newborn; pregnancy; preschool child; prevention and control; prognosis; risk factor; time; transmission; vertical transmission; Adolescent; Carcinoma, Hepatocellular; Child; Child, Preschool; Female; Hepatitis B; Humans; Immunization; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Liver Neoplasms; Male; Mothers; Pregnancy; Prognosis; Risk Factors; Survival Analysis; Time Factors
Type
journal article