Viral Hepatitis in Children (eBook)

Viral Hepatitisin Children 2
Preface 4
Contents 5
Contributors 6
Hepatitis A in Children 8
Introduction 8
Epidemiology 9
United States 9
Global 10
Risk Factors 11
The Virus 11
Clinical Features 12
Diagnosis 13
Atypical HAV 13
Treatment 15
Prevention 15
Immunoprophylaxis 15
Vaccination Implications 16
Public Health Implications 16
Current Trends 17
References 17
Epidemiology and Natural History of Hepatitis B in Children 19
Introduction 19
Epidemiology of Hepatitis B Virus Infection in Children Before the Era of Immunization Programs 20
Global 20
North America 20
Europe 21
Asia-Pacific Region 21
Africa 22
HBV Transmission in Children 22
The Effect of HBV Immunization in Children and Adolescents 23
Natural History of Hepatitis B Virus Infection in Children 24
Acute HBV Infection 25
Fulminant Hepatitis B 26
Chronic HBV Infection 26
Phase 1: Immune Tolerance Phase 27
Phase 2: Inflammatory (Immune Active) Phase 27
Phase 3: Low Replication Phase (Inactive Carrier State) 28
Phase 4: Reactivation Phase (HBeAg Negative Chronic Hepatitis B) 28
Factors Affecting the Natural Course of Hepatitis B Virus Infection 29
Maternal Factors 29
Viral Factors 29
Host Factors 30
Conclusions 30
References 30
Treatment of Chronic Hepatitis B in Children 35
Introduction 36
Acute Hepatitis B 36
Chronic Hepatitis B 36
Virological Responses 38
Clinical Responses 38
Biochemical Responses 38
Histopathological Responses 39
Medications 39
Interferon 39
HBV Polymerase Inhibitors 43
Chronic Hepatitis B and Organ Transplantation 49
Chronic HBV Infections and Renal Disease 50
HBV and Hepatitis D Virus Co-infection 51
Hepatitis C and B Virus Co-infection 51
Chronic HBV and Human Immunodeficiency Virus Co-infection 52
Summary 53
References 53
Epidemiology and Natural History of Hepatitis C in Children 60
Introduction 60
Molecular Biology 61
Epidemiology 62
Acute HCV 63
Perinatally Acquired HCV 64
Immune Response and HCV 65
HCV and Autoimmunity 65
Natural History 66
HCV and HIV 67
Conclusion 68
References 68
Treatment of Chronic Hepatitis C in Children 72
Background 72
Diagnosis and Evaluation 74
General Considerations for Treatment 76
Approved Treatments 78
Interferon-a 78
Ribavirin 79
Pegylated-Interferon 79
Adverse Events Associated with CHC Treatment 81
Interferons 81
Ribavirin 83
Treatment of Non-Responders and Those Who Relapse 83
Treatment of Special Pediatric Populations 84
Patients with Thalassemia 84
Patients with Viral Coinfections 84
Transplantation 85
Treatments in Development 85
Summary 86
References 87
Hepatitis D and Hepatitis E in Children 93
Hepatitis D 93
Description 94
Epidemiology 94
Clinical Features 95
Hepatitis D in Children 98
Pathogenesis 98
Diagnosis 98
Treatment 100
Prevention 101
Hepatitis E 102
Description 102
Epidemiology 102
Vertical Transmission 104
Clinical Features 104
Pathogenesis 106
Diagnosis 106
Treatment 106
Prevention 107
HEV Vaccines 107
References 107
Hepatitis in Children due to Non-A–E Viruses 115
Introduction 116
Congenital Viral Infections 116
Neonatal Hepatitis 117
The Herpesvirus Family 117
Cytomegalovirus 117
Epstein–Barr Virus 120
Herpes Simplex Virus 123
Human Herpesvirus 6 124
Non-Herpes Family Viruses 124
Rubella Virus 124
Enterovirus 125
Parvovirus 126
Reovirus 127
Paramyxovirus 127
HIV 127
References 130
Immunoprophylaxis of Hepatitis A and Hepatitis B in Children 132
Introduction 132
Hepatitis A 133
Passive Immunization: Immune Globulin 133
Active Immunization: Vaccine 134
Immunogenicity 134
Long-Term Immunogenicity 135
Adverse Reactions 136
Preexposure Prophylaxis (Table 2) 136
Children < 1 Year of Age
Children ³1 Year of Age 136
Groups At High Risk 138
Prevaccination Testing 139
Postvaccination Testing 139
Postexposure Prophylaxis (Table 2) 139
Conclusions 140
Hepatitis B 140
Passive Immunization: Hepatitis B Immune Globulin 140
Active Immunization: Hepatitis B Vaccine 141
Immunogenicity 141
Long-Term Immunogenicity 142
Adverse Reactions 143
Preexposure Prophylaxis (Table 4) 143
Postexposure Prophylaxis (Table 4) 144
Perinatal Exposure 144
Mucosal or Percutaneous Exposure 145
Special Circumstances 145
Chemoprophylaxis with Transplantation or Immunosuppression 145
Conclusions 146
References 146
Primary Care of Children with Viral Hepatitis: Diagnosis, Monitoring, and General Management 153
Hepatitis B 154
Natural History 154
Screening and Diagnosis 156
Medical Management of Chronic Infection 159
Hepatitis C 161
Natural History 161
Screening and Diagnosis 162
Medical Management of Chronic Infection 164
Conclusion 166
References 167
Index 170