title: Natural history of hepatitis B virus infection: pediatric perspective.
abstract: 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.
authors.affiliation: Department of Pediatrics, College of Medicine and Children's Hospital, National Taiwan University, 8 Chung-Shan South Road, Taipei, Taiwan. yhni@ntu.edu.tw
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
mesh_terms: 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
chemical_list: D017325:Hepatitis B Vaccines; D006513:Hepatitis B e Antigens
references.citation: Lancet. 2009 Feb 14;373(9663):582-92
references.pmid: 19217993
references.citation: Proc Natl Acad Sci U S A. 1990 Sep;87(17):6599-603
references.pmid: 2395863
references.citation: Gastroenterology. 2010 Mar;138(3):942-8.e1
references.pmid: 19962986
references.citation: J Infect Dis. 2009 Mar 1;199(5):742-9
references.pmid: 19199543
references.citation: J Gastroenterol Hepatol. 2002 Jun;17(6):643-50
references.pmid: 12100608
references.citation: J Natl Cancer Inst. 2000 Dec 20;92(24):2023-8
references.pmid: 11121465
references.citation: J Viral Hepat. 2003 Jul;10(4):294-7
references.pmid: 12823596
references.citation: Hepatology. 1991 Aug;14(2):219-22
references.pmid: 1860679
references.citation: Hepatology. 1995 Nov;22(5):1387-92
references.pmid: 7590652
references.citation: Oncology. 2010 Jul;78 Suppl 1:172-9
references.pmid: 20616601
references.citation: Ann Intern Med. 2001 Nov 6;135(9):796-800
references.pmid: 11694104
references.citation: J Med Virol. 1986 Apr;18(4):301-7
references.pmid: 2940332
references.citation: JAMA. 2000 Dec 20;284(23):3040-2
references.pmid: 11122592
references.citation: Nat Genet. 2009 May;41(5):591-5
references.pmid: 19349983
references.citation: Pediatr Res. 2004 Sep;56(3):396-9
references.pmid: 15240859
references.citation: Hepatology. 1999 Mar;29(3):976-84
references.pmid: 10051506
references.citation: J Viral Hepat. 2009 Feb;16(2):94-103
references.pmid: 19175878
references.citation: J Pediatr. 1987 Jul;111(1):34-9
references.pmid: 3110389
references.citation: Gastroenterology. 2004 Dec;127(6):1733-8
references.pmid: 15578511
references.citation: Hepatology. 2003 Nov;38(5):1075-86
references.pmid: 14578844
references.citation: Hepatology. 2010 Feb;51(2):435-44
references.pmid: 19918971
references.citation: MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20
references.pmid: 18802412
references.citation: J Infect Dis. 1995 Apr;171(4):776-81
references.pmid: 7706802
references.citation: J Gastroenterol Hepatol. 2000 May;15 Suppl:E25-30
references.pmid: 10921378
references.citation: Hepatology. 2008 Mar;47(3):844-53
references.pmid: 18302293
references.citation: J Med Virol. 2004 Mar;72(3):363-9
references.pmid: 14748059
references.citation: Liver Transpl. 2010 Feb;16(2):215-21
references.pmid: 20104496
references.citation: Gastroenterology. 2007 Apr;132(4):1287-93
references.pmid: 17433322
references.citation: N Engl J Med. 2010 Jun 17;362(24):2271-81
references.pmid: 20554982
references.citation: Hepatology. 2000 Jul;32(1):124-8
references.pmid: 10869299
references.citation: MMWR Recomm Rep. 2006 Dec 8;55(RR-16):1-33; quiz CE1-4
references.pmid: 17159833
references.citation: Vox Sang. 2004 Jan;86(1):28-40
references.pmid: 14984557
references.citation: J Gastroenterol Hepatol. 1998 May;13(5):541-8
references.pmid: 9641657
references.citation: J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):203-8
references.pmid: 19179883
references.citation: Gut. 2004 Oct;53(10):1499-503
references.pmid: 15361503
references.citation: Hepatology. 1992 May;15(5):770-6
references.pmid: 1568717
references.citation: Hepatology. 2006 Mar;43(3):556-62
references.pmid: 16496323
references.citation: Int J Cancer. 2007 Apr 15;120(8):1610-7
references.pmid: 17230529
references.citation: Hepatology. 1991 Feb;13(2):316-20
references.pmid: 1847352
references.citation: Gastroenterology. 2007 Jun;132(7):2340-5
references.pmid: 17570209
references.citation: J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):540-5
references.pmid: 10554120
references.citation: Hepatology. 2007 Feb;45(2):507-39
references.pmid: 17256718
references.citation: Lancet. 1990 Aug 11;336(8711):325-9
references.pmid: 1697396
references.citation: Gastroenterology. 2010 Jan;138(1):165-72.e1-3
references.pmid: 19782084
references.citation: J Gastroenterol Hepatol. 2000 May;15 Suppl:E20-4
references.pmid: 10921377
references.citation: J Virol. 1997 Jun;71(6):4852-6
references.pmid: 9151885
references.citation: Gut. 2003 Jan;52(1):122-5
references.pmid: 12477772
references.citation: J Hepatol. 1998 Jun;28(6):915-22
references.pmid: 9672164
references.citation: Ann Intern Med. 2008 Apr 1;148(7):519-28
references.pmid: 18378948
references.citation: Pediatr Transplant. 2002 Oct;6(5):378-87
references.pmid: 12390423
references.citation: JAMA. 2006 Jan 4;295(1):65-73
references.pmid: 16391218
references.citation: N Engl J Med. 1975 Apr 10;292(15):771-4
references.pmid: 1113797
references.citation: Hepatology. 1988 Mar-Apr;8(2):374-7
references.pmid: 3356419
references.citation: Hepatology. 2009 May;49(5 Suppl):S156-65
references.pmid: 19399803
references.citation: Semin Liver Dis. 2007 May;27(2):152-60
references.pmid: 17520515
references.citation: J Pediatr. 2004 Mar;144(3):397-9
references.pmid: 15001956
references.citation: J Pediatr Gastroenterol Nutr. 1993 Jan;16(1):66-9
references.pmid: 8433243
references.citation: J Natl Cancer Inst. 2001 Nov 7;93(21):1644-51
references.pmid: 11698569
references.citation: Liver Transpl. 2010 Mar;16(3):300-7
references.pmid: 20209589
references.citation: J Gastroenterol Hepatol. 1995 Jul-Aug;10(4):419-25
references.pmid: 8527708
references.citation: J Pediatr. 1989 Sep;115(3):385-90
references.pmid: 2769497
references.citation: J Pediatr. 1998 Sep;133(3):374-7
references.pmid: 9738719
references.citation: Semin Liver Dis. 2006 May;26(2):130-41
references.pmid: 16673291
references.citation: Clin Cancer Res. 2005 Nov 1;11(21):7953-7
references.pmid: 16278421
references.citation: J Hepatol. 2006 Jan;44(1):39-46
references.pmid: 16168517
references.citation: Gastroenterology. 2010 Aug;139(2):474-82
references.pmid: 20434450
references.citation: Ann Epidemiol. 2009 Apr;19(4):231-4
references.pmid: 19344859
references.citation: J Infect Dis. 2010 Apr 15;201(8):1192-200
references.pmid: 20210630
references.citation: Oncogene. 2004 Jul 29;23(34):5815-22
references.pmid: 15184870
references.citation: Virology. 1988 Sep;166(1):103-12
references.pmid: 2842938
references.citation: N Engl J Med. 2004 Mar 11;350(11):1118-29
references.pmid: 15014185
references.citation: Cancer Genet Cytogenet. 2009 Mar;189(2):71-6
references.pmid: 19215786
references.citation: N Engl J Med. 1997 Dec 11;337(24):1733-45
references.pmid: 9392700
references.citation: Cancer. 1991 Oct 15;68(8):1737-41
references.pmid: 1655224
references.citation: Hepatol Int. 2008 Sep;2(3):263-83
references.pmid: 19669255
references.citation: Am J Gastroenterol. 2008 Apr;103(4):1004-9
references.pmid: 18190649
references.citation: J Med Virol. 1993 Nov;41(3):221-9
references.pmid: 7505307