title: Unrecognized hepatitis B in pre-screened children with hematologic and oncologic conditions.
abstract: BACKGROUND
  This study evaluates the effectiveness and interpretation of hepatitis B (HBV) screening in an at-risk cohort of children with cancer or blood disorders.
  
  
  METHODS
  We conducted a retrospective epidemiologic analysis of children who screened positive for HBV (HBsAg, HbcAb) from 1999 to 2009 at a quaternary children's hospital, focusing on patients with hematologic and oncologic conditions. Descriptive statistics were generated for demographics and serologies. Follow-up of positive serologies and clinical outcomes were analyzed.
  
  
  RESULTS
  A total of 12,754 children were screened for HBV. Of 391 that screened positive, 118 had a hematologic or oncologic diagnosis. Leukemia, anemia, and thrombocytopenia comprised 84% of diagnoses. The majority (98%) tested HBcAb positive but only 20% received confirmatory HBV DNA testing. Three patients (13% of those HBV DNA tested) were identified to have chronic disease. HBV was not a known pre-existing condition, and chemotherapy preceded HBV diagnosis in all cases.
  
  
  CONCLUSIONS
  The majority of children with cancer or blood disorders who screened HBV positive did not receive follow-up DNA testing, exposing them to reactivation risk and delaying definitive therapy. HBcAb may be the only indicator of chronic HBV infection and DNA confirmation should be routine. Our findings suggest a significant number of additional patients eligible for HBV treatment may have been identified with reflexive DNA testing.
authors.affiliation: Baylor College of Medicine, Pediatrics, Houston, Texas; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, Texas.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Leung
authors.forename: David C
authors.initials: DC
authors.lastname: Ahamba
authors.forename: Lekshmi N
authors.initials: LN
authors.lastname: Pillai
authors.forename: Mahjabeen F
authors.initials: MF
authors.lastname: Khan
authors.forename: E O'Brian
authors.initials: EO
authors.lastname: Smith
authors.forename: Donald H
authors.initials: DH
authors.lastname: Mahoney
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000175:diagnosis* / Q000821:virology; D006509:Hepatitis B / Q000175:diagnosis* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000472:pathogenicity*; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D009369:Neoplasms / Q000175:diagnosis* / Q000821:virology; D011379:Prognosis; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014775:Virus Activation
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens
keywords: BMT; Hepatitis B; chemotherapy; pediatric hematology and oncology; screening; viral infection