Persistent hepatitis B virus replication after survival of fulminant hepatitis and clearance of HBsAG

Infantile hepatitis B in immunized children: risk for fulminant hepatitis and long-term outcomes

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 HBV-positive 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.

Transmission of hepatitis B virus (genotype E) in a haemodialysis unit

BACKGROUND

The Rosenheim report, published in 1972, was aimed at decreasing the transmission of hepatitis B virus (HBV) in the renal unit. A review in 1996, revealed the non-compliance of some centres with the guidance to vaccinate individuals against HBV.

OBJECTIVES

To describe two events of acute hepatitis B virus (HBV) infection within 9 weeks in individuals attending the renal unit and the steps taken to prevent further transmission.

STUDY DESIGN

Serological and molecular testing was carried out on the two individuals with acute HBV and other HBV carriers in the unit. Epidemiological information was collected along with information on HBV vaccination and HBsAg screening.

RESULTS

There were 15 known HBV carriers in the unit. HBV genotype E was transmitted from a carrier to patient 1 when they were in the same ward. Transmission to patient 2 occurred when he followed patient 1 on the theatre list. Breaks in infection control were identified and steps were taken to prevent further transmission events.

CONCLUSIONS

Breaks in infection control procedures were rectified. No further transmission of HBV was identified. This highlights the need for vigilance regarding infection control practices in the renal unit setting.