Hepatitis is often a silent virus with few if any signs. The effects of the virus if it becomes chronic rarely are immediately revealed because the damage occurs after years of infection. Hepatitis also infects children and impacts upon their lives sometimes as early as 8 years of age. Children with chronic hepatitis cannot be treated simply like miniature adults. Specific issues and questions need to be addressed when dealing with the pediatric age group.

Pediatric patients are less likely than adults to have symptoms of infection with hepatitis B or hepatitis C, leaving the viruses undetected and possibly unknowingly spread. In HBV, transmission between peers is common in children stressing the need for vaccination of all children for hepatitis B. In the household of a chronic carrier of HBV, transmission is more likely to occur between siblings than child-to-parent or parent-to-child.

The younger patients are when hepatitis B infection occurs, the more likely they are to become chronic carriers. According to Dr. Teddy F. Bader, author of "Viral Hepatitis, Practical Evaluation and Treatment", information available on the natural history of HCV shows the percentage of children who become chronic and the long-term outcomes are similar to the percentage of adults. Children who are chronic carriers of HBV, with or without chronic hepatitis or chronic HCV, have normal growth patterns.

"Liver biopsy appears to be less valuable in children than adults", states Dr. Bader. Chronic hepatitis rarely progresses to cirrhosis in children. In 16 HCV children followed for up to 14 years, encephalopathy (mental confusion), ascites (swollen abdomen), or bleeding did not develop. The lack of cirrhosis in children with HCV is consistent that a time period of 10 to 20 years or more is required for cirrhosis to occur. According to Dr. Bader, in a one 10-year follow-up study of 166 Italian children with only chronic HBV, none developed cirrhosis. An increased risk of cirrhosis exists in children with HBV if there is a second infection, either delta hepatitis or hepatitis C. Hepatocellular carcinoma (cancer of the liver) occurs very rarely in the pediatric group.

The US FDA has not approved the use of alpha-interferon IIb (IFN) for patients less than age 18. Few studies exist examining IFN use in children with chronic HBV or HCV. A recent study by Bortolotti, et al. in "Hepatology" suggests that IFN therapy may benefit children with chronic HCV. The rates of initial and long-lasting response were higher in the study than those observed in adults treated with standard schedules. Possible explanations include the shorter time of infection in children, and that most have a mild form of liver disease. Both factors were associated with a better response to IFN treatment in adults. The results of this study are encouraging, according to the researchers, but more investigation needs to be conducted. According to Dr. Bader, the available data suggests that pediatric HBV carriers should not be routinely treated with alpha-interferon.

Many questions still remain about chronic hepatitis B and C in children. Further studies need to be done to determine the diseases' courses and progress as well as the role of IFN treatment.

Article from Hepatitis Alert, Volume II, No. I, Winter 1996. Published by the Hepatitis Foundation International, 30 Sunrise Terrace, Cedar Grove, NJ 07009 (1-800-891-0707)

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