TY - JOUR
T1 - Infantile hepatitis B in immunized children
T2 - Risk for fulminant hepatitis and long-term outcomes
AU - Tseng, Yu Ru
AU - Wu, Jia Feng
AU - Kong, Man Shan
AU - Hu, Fu Chang
AU - Yang, Yao Jong
AU - Yeung, Chun Yan
AU - Huang, Fu Chen
AU - Huang, I. Fei
AU - Ni, Yen Hsuan
AU - Hsu, Hong Yuan
AU - Chang, Mei Hwei
AU - Chen, Huey Ling
N1 - Publisher Copyright:
© 2014 PLOS ONE.
PY - 2014/11/7
Y1 - 2014/11/7
N2 - Background: Infantile hepatitis B after neonatal immunoprophylaxis is a rare yet distinct disease. This study aimed to analyze the long-term outcomes and risk factors in immunized infants with hepatitis B.Methods: The clinical parameters and outcomes of 41 infants born after universal immunization, and admitted for HBVpositive hepatitis were studied. All patients were followed for at least 6 months (median = 4.4 years, range 0.6-18.1 years). Patient survival, changes of HBsAg and HBeAg status, and complications were analyzed.Results: Among the 41 cases (32 males, 9 females), 21 presented with fulminant hepatitis (FH), and 20 with non-fulminant hepatitis (NFH). Ninety-five percent (36/38) of the mothers were positive for hepatitis B surface antigen (HBsAg). Multivariate analyses revealed younger age of onset (age <7 months) and negative maternal hepatitis B e antigen (HBeAg) were associated with FH (p = 0.03 and p = 0.01, respectively). An infantile fulminant hepatitis B risk score using maternal/infant HBeAg positivity and onset age was proposed. Among the FH cases, the rate of mortality, HBsAg clearance, and chronic HBV infection were 47.6%, 38.1%, and 14.3%, respectively. Among the NFH cases, 35% developed chronic infection. Of the 9 chronically infected children received long-term follow-up, 8 had HBeAg seroconversion before 4 years of age. One case of FH developed hepatocellular carcinoma 14 years later.Conclusions: Maternal HBsAg +/HBeAg- and early onset age were risk factors for FH in immunized infants. A significant portion of patients with FH or NFH evolve to chronic HBV infection, with HBeAg seroconversion in young childhood. Close surveillance for hepatocellular carcinoma is warranted in patients surviving infantile hepatitis B.
AB - Background: Infantile hepatitis B after neonatal immunoprophylaxis is a rare yet distinct disease. This study aimed to analyze the long-term outcomes and risk factors in immunized infants with hepatitis B.Methods: The clinical parameters and outcomes of 41 infants born after universal immunization, and admitted for HBVpositive hepatitis were studied. All patients were followed for at least 6 months (median = 4.4 years, range 0.6-18.1 years). Patient survival, changes of HBsAg and HBeAg status, and complications were analyzed.Results: Among the 41 cases (32 males, 9 females), 21 presented with fulminant hepatitis (FH), and 20 with non-fulminant hepatitis (NFH). Ninety-five percent (36/38) of the mothers were positive for hepatitis B surface antigen (HBsAg). Multivariate analyses revealed younger age of onset (age <7 months) and negative maternal hepatitis B e antigen (HBeAg) were associated with FH (p = 0.03 and p = 0.01, respectively). An infantile fulminant hepatitis B risk score using maternal/infant HBeAg positivity and onset age was proposed. Among the FH cases, the rate of mortality, HBsAg clearance, and chronic HBV infection were 47.6%, 38.1%, and 14.3%, respectively. Among the NFH cases, 35% developed chronic infection. Of the 9 chronically infected children received long-term follow-up, 8 had HBeAg seroconversion before 4 years of age. One case of FH developed hepatocellular carcinoma 14 years later.Conclusions: Maternal HBsAg +/HBeAg- and early onset age were risk factors for FH in immunized infants. A significant portion of patients with FH or NFH evolve to chronic HBV infection, with HBeAg seroconversion in young childhood. Close surveillance for hepatocellular carcinoma is warranted in patients surviving infantile hepatitis B.
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U2 - 10.1371/journal.pone.0111825
DO - 10.1371/journal.pone.0111825
M3 - Article
C2 - 25380075
AN - SCOPUS:84915817122
SN - 1932-6203
VL - 9
JO - PloS one
JF - PloS one
IS - 11
M1 - e111825
ER -