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Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination
Author(s) -
Chen HueyLing,
Chang CheeJen,
Kong ManShan,
Huang FuChen,
Lee HungChang,
Lin ChiehChung,
Liu ChingChuan,
Lee IHsien,
Wu TzeeChung,
Wu ShuFen,
Ni YenHsuan,
Hsu HongYuan,
Chen DingShinn,
Chang MeiHwei
Publication year - 2004
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20006
Subject(s) - medicine , fulminant hepatitis , fulminant , virology , vaccination , fulminant hepatic failure , hepatitis b , immunology , hepatitis , liver transplantation , transplantation
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. (H EPATOLOGY 2004;39:58–63.)