Natural history of hepatitis B virus infection: pediatric perspective.
Hepatitis B virus (HBV) infection is an important disease globally. Chronic HBV infection may result in serious complications. Its transmission may be either perinatal or horizontal. Perinatal transmission is particularly important after the implementation of a universal vaccination program. Through either route, chronic carrier status is usually established in early childhood. The course of the disease course is determined by the host-virus interaction. The host's immune system initially tolerates the virus, and then gradually attempts to clear it. The virus, on the other hand, tries to avoid host immune system attack by a strategy involving targeted epitope mutations. By generating mutants, the virus can survive attacks from the host's immune system, enabling the infection to persist. Different individuals have different responses to HBV infection; genetic polymorphisms in cytokines, hormones, and other immune modulators may affect the final outcome of chronic HBV infection. Due to the implementation of a universal infant HBV vaccination program, HBV infection is now under control. Unfortunately, there still are some cases of vaccination failure. Very high maternal viremia, in utero infection, or escape mutants are possible reasons for vaccination failure. Immunocompromised hosts also risk vaccination failure. Blood or organ donors with occult HBV infection are possible sources for immunocompromised hosts. These victims of vaccination failure may exhibit a different disease course due to chronic HBV infection from those who acquired the infection before the universal vaccination era. The achievement of our ultimate goal of HBV elimination depends on a globally effective universal vaccination program, as well as the application of some novel successful medications to control those who are already infected.
Ni
Yen-Hsuan
YH
Department of Pediatrics, College of Medicine and Children's Hospital, National Taiwan University, 8 Chung-Shan South Road, Taipei, Taiwan. yhni@ntu.edu.tw
D002675:Child, Preschool; D018450:Disease Progression; D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D016867:Immunocompromised Host; D007231:Infant, Newborn; D032541:Mass Vaccination; D009154:Mutation; D011110:Polymorphism, Genetic; D014766:Viremia
D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens
Lancet. 2009 Feb 14;373(9663):582-92
19217993
Proc Natl Acad Sci U S A. 1990 Sep;87(17):6599-603
2395863
Gastroenterology. 2010 Mar;138(3):942-8.e1
19962986
J Infect Dis. 2009 Mar 1;199(5):742-9
19199543
J Gastroenterol Hepatol. 2002 Jun;17(6):643-50
12100608
J Natl Cancer Inst. 2000 Dec 20;92(24):2023-8
11121465
J Viral Hepat. 2003 Jul;10(4):294-7
12823596
Hepatology. 1991 Aug;14(2):219-22
1860679
Hepatology. 1995 Nov;22(5):1387-92
7590652
Oncology. 2010 Jul;78 Suppl 1:172-9
20616601
Ann Intern Med. 2001 Nov 6;135(9):796-800
11694104
J Med Virol. 1986 Apr;18(4):301-7
2940332
JAMA. 2000 Dec 20;284(23):3040-2
11122592
Nat Genet. 2009 May;41(5):591-5
19349983
Pediatr Res. 2004 Sep;56(3):396-9
15240859
Hepatology. 1999 Mar;29(3):976-84
10051506
J Viral Hepat. 2009 Feb;16(2):94-103
19175878
J Pediatr. 1987 Jul;111(1):34-9
3110389
Gastroenterology. 2004 Dec;127(6):1733-8
15578511
Hepatology. 2003 Nov;38(5):1075-86
14578844
Hepatology. 2010 Feb;51(2):435-44
19918971
MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
18802412
J Infect Dis. 1995 Apr;171(4):776-81
7706802
J Gastroenterol Hepatol. 2000 May;15 Suppl:E25-30
10921378
Hepatology. 2008 Mar;47(3):844-53
18302293
J Med Virol. 2004 Mar;72(3):363-9
14748059
Liver Transpl. 2010 Feb;16(2):215-21
20104496
Gastroenterology. 2007 Apr;132(4):1287-93
17433322
N Engl J Med. 2010 Jun 17;362(24):2271-81
20554982
Hepatology. 2000 Jul;32(1):124-8
10869299
MMWR Recomm Rep. 2006 Dec 8;55(RR-16):1-33; quiz CE1-4
17159833
Vox Sang. 2004 Jan;86(1):28-40
14984557
J Gastroenterol Hepatol. 1998 May;13(5):541-8
9641657
J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):203-8
19179883
Gut. 2004 Oct;53(10):1499-503
15361503
Hepatology. 1992 May;15(5):770-6
1568717
Hepatology. 2006 Mar;43(3):556-62
16496323
Int J Cancer. 2007 Apr 15;120(8):1610-7
17230529
Hepatology. 1991 Feb;13(2):316-20
1847352
Gastroenterology. 2007 Jun;132(7):2340-5
17570209
J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):540-5
10554120
Hepatology. 2007 Feb;45(2):507-39
17256718
Lancet. 1990 Aug 11;336(8711):325-9
1697396
Gastroenterology. 2010 Jan;138(1):165-72.e1-3
19782084
J Gastroenterol Hepatol. 2000 May;15 Suppl:E20-4
10921377
J Virol. 1997 Jun;71(6):4852-6
9151885
Gut. 2003 Jan;52(1):122-5
12477772
J Hepatol. 1998 Jun;28(6):915-22
9672164
Ann Intern Med. 2008 Apr 1;148(7):519-28
18378948
Pediatr Transplant. 2002 Oct;6(5):378-87
12390423
JAMA. 2006 Jan 4;295(1):65-73
16391218
N Engl J Med. 1975 Apr 10;292(15):771-4
1113797
Hepatology. 1988 Mar-Apr;8(2):374-7
3356419
Hepatology. 2009 May;49(5 Suppl):S156-65
19399803
Semin Liver Dis. 2007 May;27(2):152-60
17520515
J Pediatr. 2004 Mar;144(3):397-9
15001956
J Pediatr Gastroenterol Nutr. 1993 Jan;16(1):66-9
8433243
J Natl Cancer Inst. 2001 Nov 7;93(21):1644-51
11698569
Liver Transpl. 2010 Mar;16(3):300-7
20209589
J Gastroenterol Hepatol. 1995 Jul-Aug;10(4):419-25
8527708
J Pediatr. 1989 Sep;115(3):385-90
2769497
J Pediatr. 1998 Sep;133(3):374-7
9738719
Semin Liver Dis. 2006 May;26(2):130-41
16673291
Clin Cancer Res. 2005 Nov 1;11(21):7953-7
16278421
J Hepatol. 2006 Jan;44(1):39-46
16168517
Gastroenterology. 2010 Aug;139(2):474-82
20434450
Ann Epidemiol. 2009 Apr;19(4):231-4
19344859
J Infect Dis. 2010 Apr 15;201(8):1192-200
20210630
Oncogene. 2004 Jul 29;23(34):5815-22
15184870
Virology. 1988 Sep;166(1):103-12
2842938
N Engl J Med. 2004 Mar 11;350(11):1118-29
15014185
Cancer Genet Cytogenet. 2009 Mar;189(2):71-6
19215786
N Engl J Med. 1997 Dec 11;337(24):1733-45
9392700
Cancer. 1991 Oct 15;68(8):1737-41
1655224
Hepatol Int. 2008 Sep;2(3):263-83
19669255
Am J Gastroenterol. 2008 Apr;103(4):1004-9
18190649
J Med Virol. 1993 Nov;41(3):221-9
7505307