HEPATITIS B AND C IN CHILDREN
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
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
"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
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
Article from Hepatitis Alert, Volume II,
No. I, Winter 1996. Published by the Hepatitis Foundation
International, 30 Sunrise Terrace, Cedar Grove, NJ 07009