title: Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination.
abstract: 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.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Man-Shan
authors.initials: MS
authors.lastname: Kong
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Huang
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Lee
authors.forename: Chieh-Chung
authors.initials: CC
authors.lastname: Lin
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Liu
authors.forename: I-Hsien
authors.initials: IH
authors.lastname: Lee
authors.forename: Tzee-Chung
authors.initials: TC
authors.lastname: Wu
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Wu
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Hong-Yuan
authors.initials: HY
authors.lastname: Hsu
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Mei-Hwei
authors.initials: MH
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D005260:Female; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D019694:Hepatitis B, Chronic / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007223:Infant; D017093:Liver Failure / Q000401:mortality* / Q000821:virology*; D008297:Male; D009035:Mothers; D012042:Registries; D017678:Sex Distribution; D013624:Taiwan / Q000453:epidemiology
chemical_list: D017325:Hepatitis B Vaccines