Infantile hepatitis B in immunized children: risk for fulminant hepatitis and long-term outcomes.
BACKGROUND
Infantile hepatitis B after neonatal immunoprophylaxis is a rare yet distinct disease. This study aimed to analyze the long-term outcomes and risk factors in immunized infants with hepatitis B.


METHODS
The clinical parameters and outcomes of 41 infants born after universal immunization, and admitted for HBV-positive hepatitis were studied. All patients were followed for at least 6 months (median  = 4.4 years, range 0.6-18.1 years). Patient survival, changes of HBsAg and HBeAg status, and complications were analyzed.


RESULTS
Among the 41 cases (32 males, 9 females), 21 presented with fulminant hepatitis (FH), and 20 with non-fulminant hepatitis (NFH). Ninety-five percent (36/38) of the mothers were positive for hepatitis B surface antigen (HBsAg). Multivariate analyses revealed younger age of onset (age <7 months) and negative maternal hepatitis B e antigen (HBeAg) were associated with FH (p = 0.03 and p = 0.01, respectively). An infantile fulminant hepatitis B risk score using maternal/infant HBeAg positivity and onset age was proposed. Among the FH cases, the rate of mortality, HBsAg clearance, and chronic HBV infection were 47.6%, 38.1%, and 14.3%, respectively. Among the NFH cases, 35% developed chronic infection. Of the 9 chronically infected children received long-term follow-up, 8 had HBeAg seroconversion before 4 years of age. One case of FH developed hepatocellular carcinoma 14 years later.


CONCLUSIONS
Maternal HBsAg + /HBeAg- and early onset age were risk factors for FH in immunized infants. A significant portion of patients with FH or NFH evolve to chronic HBV infection, with HBeAg seroconversion in young childhood. Close surveillance for hepatocellular carcinoma is warranted in patients surviving infantile hepatitis B.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Ru
YR
Tseng
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Jia-Feng
JF
Wu
Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan.
Man-Shan
MS
Kong
Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
Fu-Chang
FC
Hu
Department of Pediatrics, Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University and Hospital, Tainan, Taiwan.
Yao-Jong
YJ
Yang
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Chun-Yan
CY
Yeung
Department of Pediatrics, Chang-Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Fu-Chen
FC
Huang
Department of Pediatrics, Veterans General Hospital, Kaohsiung, Taiwan.
I-Fei
IF
Huang
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Yen-Hsuan
YH
Ni
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education and Bioethics, National Taiwan University, College of Medicine, Taipei, Taiwan.
Hong-Yuan
HY
Hsu
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Mei-Hwei
MH
Chang
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Education and Bioethics, National Taiwan University, College of Medicine, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
Huey-Ling
HL
Chen
D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007114:Immunization; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors