05:02am Monday 18 December 2017

New Recommendations Issued for Children with Chronic Hepatitis B Infections

KathySchwarz

 

The panel recommends that pediatricians and other primary care practitioners stress the need for routine monitoring of children with chronic HBV infections, and timely consultation with a pediatric liver specialist.

“Most children with chronic HBV infection are asymptomatic, lacking any signs or symptoms of disease,” said Schwarz of Johns Hopkins Children’s Center, panel member and a co-author of the report. Schwarz stressed, however, that “this is a progressive disease, and children infected chronically with HBV have an increased risk of severe complications as teens or adults, including cirrhosis, and even liver cancer. This is why screening and identification of HBV infection in children is essential.”

Chronic HBV infection remains a serious health concern in populations who are not vaccinated against HBV, or are who are exposed prior to being vaccinated. The panel’s report discusses the importance of screening children in high-risk groups, such as those born in countries endemic for HBV. A challenge facing pediatricians is the lack of clear screening, monitoring and treatment guidelines.

“Because the majority of infants born in the U.S. are now vaccinated against HBV, most pediatricians don’t encounter chronic HBV infection very frequently,” said lead author Barbara A. Haber, MD, of the Children’s Hospital of Philadelphia. “And often times children at risk, including immigrants from endemic areas, are not screened and remain undiagnosed.”

The panel’s report provides recommendations for primary care providers on the initial management of these children, including what tests to conduct to periodically monitor disease progression, and when, based on the test results, a pediatric liver specialist should be consulted. The report includes a flow chart outlining the recommendations, which cover liver function testing, hepatitis B serology and DNA levels, liver ultrasound, alpha-fetoprotein (AFP) testing, and family history. The panel advocates for referral of any child with elevated serum liver enzyme levels, elevated AFP levels, or a family history of liver disease or liver cancer.

“The decision whether or not to treat needs to be evaluated carefully by a pediatrician or specialist familiar with indications for treatment of chronic HBV,” Dr. Schwarz said. “The right treatment at the right time can enhance quality and length of life. Inappropriate or unnecessary treatment can result in the emergence of drug-resistant strains of the virus, potentially limiting our treatment options for the future.”

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Related Information:

Hepatitis B Foundation

Founded in 1912 as the children’s hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. Hopkins Children’s is consistently ranked among the top children’s hospitals in the nation. Hopkins Children’s is Maryland’s largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. For more information, please visit www.hopkinschildrens.org


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