CHRONIC HEPATITIS B INFECTION IN PEDIATRIC POPULATION: A RETROSPECTIVE STUDY FROM A TERTIARY CENTER IN NORTH-EASTERN ROMANIA

  • Lorenza FORNA “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi
  • Laura BOZOMITU “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi
  • V.V. LUPU “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi
  • Ancuta LUPU “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi
  • Camelia COJOCARIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Carmen ANTON “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Irina GIRLEANU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Cristina Maria MUZICA “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Anca TRIFAN “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

Chronic viral hepatitis B is the precursor stage of cirrhosis and the 10th leading cause of death worldwide. WHO estimated in 2019 that approximately 296 million people were chronically infected with the hepatitis B virus and over 800,000 deaths. The aim of study was to describe characteristics of chronic HBV infection in pediatric population from a tertiary center in North-Eastern Romania. Materials and Methods: A retrospective study was conducted on 148 pediatric patients with chronic HBV infection who had visits from 2011 to 2019 to St. Mary’s Hospital Iasi (Romania). The HVB infection in study group was analyzed regarding demographic characteristics, distribution of pediatric patients in relation to vaccination status, risk factors, HBV infection stage, and clinical manifestations. The qualitative variables were characterized through frequencies distributions. The quantitative variables were characterized through descriptive statistics (averages, standard deviations). P < 0.05 was the threshold for significance. Results: Most of the patients (87,83%) had vertical transmission, while 18.91% had horizontal transmission. Most of the pediatric population was vaccinated (87.83%), while 11.48% had incomplete vaccination. The most common risk factor was vertical transmission (81.8%), followed by horizontal transmission, surgical interventions (10.13%), frequent hospitalizations (4.1%), and dental procedures (3.4%). Among patients with HBV infection, most of them presented loss of appetite (16.2%), followed by abdominal pain (12.8%), hepatomegaly (12.2%), and physical asthenia (4.1%). Conclusions: Most children from our study were in chronic hepatitis B phase and immune-tolerant phase. Pediatric patients with chronic viral B infection can experience a slow progression of the disease without specific signs and symptoms for a long period, especially when the diagnosis is made at an infant or young child age.

Author Biographies

Lorenza FORNA, “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi

“Grigore T. Popa” University of Medicine and Pharmacy Iasi

Laura BOZOMITU, “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi

“Grigore T. Popa” University of Medicine and Pharmacy Iasi

V.V. LUPU, “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi

“Grigore T. Popa” University of Medicine and Pharmacy Iasi

Ancuta LUPU, “Sf. Maria” Clinical Emergency Children’s Hospital, Iasi

“Grigore T. Popa” University of Medicine and Pharmacy Iasi

Camelia COJOCARIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Department of Clinical Gastroenterology

Carmen ANTON, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Department of Clinical Gastroenterology

Irina GIRLEANU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Department of Clinical Gastroenterology

Cristina Maria MUZICA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Department of Clinical Gastroenterology

Anca TRIFAN, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania
Department of Clinical Gastroenterology

References

1. Perez-Molina JA, Cancio-Suárez MR, Moreno S. Is It Time for Treatment as Prevention of Chronic Hepatitis B? Pathogens 2023; 12(9): 1137 / doi: 10.3390/pathogens12091137.
2. Indolfi G, Easterbrook P, Dusheiko G, et al. Hepatitis B virus infection in children and adoles-cents. Lancet Gastroenterol. Hepatol. 2019; 4: 466-476 / doi: 10.1016/S2468-1253 (19)30042-1.
3. World Health Organization. Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis and Sexually Transmitted Infections for the Period 2022–2030. World Health Organization; Geneva, Switzerland: 2022.
4. Pinto RB, Schneider AC, da Silveira TR. Cirrhosis in children and adolescents: An overview. World J Hepatol 2015; 7(3): 392-405.
5. Sokal EM, Paganelli M, Wirth S, et al. European Society of Pediatric Gastroenterology, Hepatology and Nutrition. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol 2013; 59(4): 814-29.
6. Bertoletti A, Kennedy PT. The immune tolerant phase of chronic HBV infection: new perspectives on an old concept. Cell Mol Immunol 2015; 12(3): 258e63.
7. Won-Mook Choi, Jonggi Choi, Young-Suk Lim, Chapter 7 - Hepatitis B: epidemiology, natural histo-ry, and diagnosis, Editor(s): Wai-Kay Seto, Mohammed Eslam. Comprehensive Guide to Hepatitis Advances, Academic Press, 2023, 183-203.
8. Brunetto MR, Oliveri F, Colombatto P, et al. Hepatitis B surface antigen serum levels help to distin-guish active from inactive hepatitis B virus genotype D carriers. Gastroenterology 2010; 139(2): 483e90.
9. https://www.aasld.org/practice-guidelines
10. Paganelli M, Stephenne X, Sokal EM. Chronic hepatitis B in children and adolescents. J Hepatol 2012; 57(4): 885-896.
11. AAP COMMITTEE ON INFECTIOUS DISEASES and AAP COMMITTEE ON FETUS AND NEWBORN. Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth. Pediatrics 2017; 140(3): e20171870.
12. Veronese P, Dodi I, Esposito S, Indolfi G. Prevention of vertical transmission of hepatitis B virus infection. World J Gastroenterol 2021; 27(26): 4182-4193.
13. Cheung KW, Lao TT. Hepatitis B - Vertical transmission and the prevention of mother-to-child transmission. Best Pract Res Clin Obstet Gynaecol 2020; 68: 78-88.
14. Zhao H, Zhou X, Zhou YH. Hepatitis B vaccine development and implementation. Hum Vaccin Immunother 2020; 16(7): 1533-1544.
15. Al-Busafi SA, Al-Harthi R, Al-Naamani K, Al-Zuhaibi H, Priest P. Risk Factors for Hepatitis B Virus Transmission in Oman. Oman Med J 2021; 36(4): e287 / doi: 10.5001/ omj.2021.99.)
16. Pattyn J, Hendrickx G, Vorsters A, Van Damme P. Hepatitis B Vaccines. J Infect Dis 2021; 224(12 Suppl 2): S343-S351 / doi: 10.1093/infdis/jiaa6682021:224 (Suppl 4): S343.
17. Chang MH. Natural history and clinical management of chronic hepatitis B virus infection in children. Hepatol Int. 2008; 2(Suppl. 1): 28-36 / doi: 10.1007/s12072-008-9050-9.
Published
2024-03-29
Section
INTERNAL MEDICINE - PEDIATRICS