Hepatitis B virus and hepatitis C virus infections in children.
OBJECTIVE
To analyse the most relevant recent information on efficacy, duration and coverage of anti-hepatitis B virus vaccination; correlates of mother-to-child hepatitis C virus transmission; the natural history and outcomes of hepatitis B and C virus infections in children; the efficacy and safety of specific therapies.


RESULTS
Insufficient hepatitis B virus vaccine coverage and incomplete or delayed vaccine cycles need improvement in many countries. Hepatitis B virus mutants may explain some fulminant hepatitis in perinatally infected infants and vaccine failures. No interventions to prevent vertical hepatitis C virus transmission have been identified. Spontaneous clearance of hepatitis B is lower in children than in adults, while the rates appear to be similar for hepatitis C. The disease progression is slower for both infections in childhood. Several studies support the efficacy and safety of interferons and lamivudine in chronic hepatitis B or of interferons and ribavirin in chronic hepatitis C in children, but the optimal therapy remains unclear.


CONCLUSIONS
There are doubts as to the long-term persistence of anti-hepatitis B immunization in low-endemicity areas. Routine hepatitis C virus testing in pregnancy is not recommended as there are no available prophylactic measures. Although hepatitis B and C virus infections are usually asymptomatic or with mild manifestations in childhood, concerns around their long-term clinical impact suggest the need for early treatment. Children should preferably be treated in the context of targeted trials for a better understanding of the efficacy and tolerance of drugs currently used in adults.
Tovo
Pier-Angelo
PA
Department of Pediatrics, University of Turin, Turin, Italy. pierangelo.tovo@unito.it
Lazier
Luisella
L
Versace
Antonia
A
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016174:Hepacivirus / Q000187:drug effects; D006509:Hepatitis B / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control / Q000821:virology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology; D006515:Hepatitis B virus / Q000187:drug effects / Q000276:immunology; D006526:Hepatitis C / Q000188:drug therapy / Q000503:physiopathology / Q000635:transmission / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016896:Treatment Outcome; D014611:Vaccination
D000998:Antiviral Agents; D017325:Hepatitis B Vaccines