Chronic Hepatitis B

Chronic Hepatitis B in Children Kevin E. Nelson Morning Report November 5, 2009

Chronic Hepatitis B 



Worldwide: 10-30 million new cases, 400 million total cases 

Vertical transmission



90% develop chronic HBV infection

U.S: At least 1.25 million people infected with HBV 

Chronic HBV higher among immigrant population



At risk for cirrhosis, hepatic decompensation, hepatocellular carcinoma

Hepatitis B Serology Acute HBsAg

Usually +

Resolved -

Chronic +

Vaccinated -

Anti HBc

+

+

+

-

Ant HBc IgM

+

-

+

-

Anti HBe Ag

+

-

+/-

-

Anti HBe Ab

-

-

+/-

-

Anti HBs

-

+

-

+

Hep B DNA

+

-

+

-

Evaluation/Treatment 

  

Initial testing: LFTs, Viral hepatitis, autoimmune hepatitis, Wilson’s disease HBV workup: HBV serology, Liver imaging (US), biopsy Liver, pancreas and kidney are HBV reservoirs Antiviral treatment (interferon/nucleoside analogs) 

Who?   



HBV DNA >20,000, HBeAg positive HBV DNA > 2000, HBeAg negative Liver cirrhosis

Nursery – HBIG within first 12 hours of life if HBsAg Mom

Acknowledgements/References Dr. Linda S. Book Dr. John Pohl Dienstag, JL, N Engl J Med 359;14:1486-1500. Haber BA, Pediatrics. 2009:Oct 5. epub ahead of print. Keefe, EB, et. al, Clin Gastroenterol H, 2008;6:1315-1341. Mozer-Lisewska I, Eur J Gastroenterol Hepatol 2009:Sep 25, epub ahead of print. Delaware Valley Hepatitis treatment research and education center. www.heptrec.org/HepaitiB.asp, Accessed 11/06/09 Voices from the Blue Nile, Ukuda tribe refugee settlement in Bonga, Ethiopia, http://www.voicesfromthebluenile.org/, Accessed 11/06/09.