Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination

• Published in: Hepatology (Baltimore, Md.) Vol. 39; no. 1; pp. 58 - 63
• Main Authors: Chen, Huey‐Ling, Chang, Chee‐Jen, Kong, Man‐Shan, Huang, Fu‐Chen, Lee, Hung‐Chang, Lin, Chieh‐Chung, Liu, Ching‐Chuan, Lee, I‐Hsien, Wu, Tzee‐Chung, Wu, Shu‐Fen, Ni, Yen‐Hsuan, Hsu, Hong‐Yuan, Chen, Ding‐Shinn, Chang, Mei‐Hwei
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2004; Wiley
• Subjects: Adolescent; Adult; Age Distribution; Biological and medical sciences; Child; Child, Preschool; Endemic Diseases; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B Vaccines - administration & dosage; Hepatitis B, Chronic - mortality; Hepatitis B, Chronic - prevention & control; Human viral diseases; Humans; Incidence; Infant; Infectious diseases; Liver Failure - mortality; Liver Failure - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Mothers; Other diseases. Semiology; Registries; Sex Distribution; Taiwan - epidemiology; Viral diseases; Viral hepatitis; Taiwan; Human; Pediatrics; Vaccination; Hepatic disease; Fulminant; Infection; Prevention; Viral hepatitis B; Immunoprophylaxis; Liver failure; Area; Viral disease; Gastroenterology; Digestive diseases; Child
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.20006

To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant hepatic failure (FHF) after the launch of universal HBV vaccination, the authors analyzed the data from patients with FHF collected from a nationwide collaborative study group. Children aged 1 month to 15 years who were diagnosed with FHF (62 males and 33 females) between 1985–1999 were included. HBV infection (hepatitis B surface antigen [HBsAg] and/or immunoglobulin M hepatitis B core antibody [IgM anti‐HBc] seropositive) accounted for 46% (43 of 95 cases) of all the cases of FHF. The average annual incidence of FHF in the time period 1985–1999 was 0.053/100,000 in the group of patients ages 1–15 years and 1.29/100,000 in those patients age < 1 year. Approximately 61% (58 of 95 cases) of all FHF cases were infants. The percentage of HBV infection was found to be higher in infants (57%) compared with children ages 1–15 years (27%) (P = 0.004). The incidence rate ratio of those patients age < 1 year to those ages 1–15 years was 54.2 for HBV‐positive FHF and 15.2 for HBV‐negative FHF. Maternal HBsAg was found to be positive in 97% of the infants with HBV‐positive FHF, and hepatitis B e antigen (HBeAg) was found to be negative in 84% of these infants. Approximately 74% of all HBV‐positive FHF patients and 81% of the infantile HBV‐positive patients had been vaccinated. In conclusion, within the first 15 years of universal vaccination, HBV was found to rarely cause FHF in children age > 1 year but remained a significant cause of FHF in infants. HBV‐positive FHF was prone to develop in infants born to HBeAg‐negative, HBsAg‐carrier mothers; these infants had not received hepatitis B immunoglobulin according to the vaccination program in place. (HEPATOLOGY 2004;39:58–63.)