Improved monitoring for progression of disease in affected children is essential
An expert panel of nationally recognized pediatric liver specialists convened by the Hepatitis B Foundation is calling for more consistent monitoring and referral of children chronically infected with the hepatitis B virus (HBV). The panel's recommendations for pediatricians and other primary care practitioners stress the need for routine monitoring of children with chronic HBV infections, and timely consultation with a pediatric liver specialist. Their report, published online October 5, 2009 in Pediatrics, is the outcome of a meeting hosted on November 11, 2008 at the Foundation's headquarters in Bucks County, PA. "The lack of clear guidance for the care of affected children is a great concern for parents," said Joan Block, RN, BSN, executive director of the Hepatitis B Foundation. To begin to address this gap, the Foundation brought together seven leading pediatric hepatologists for the first-of-its-kind forum, which was facilitated by two thought leaders in hepatitis B research and treatment.
"Because the majority of infants born in the U.S. are now vaccinated against HBV, most pediatricians don't encounter chronic HBV infection very frequently," said lead author Barbara A. Haber, M.D., of the Children's Hospital of Philadelphia. "And often times children at risk, including immigrants from endemic areas, are not screened and remain undiagnosed."
Chronic HBV infection remains a serious health concern in populations who are not vaccinated, or who are exposed prior to being vaccinated. The panel's report discusses the importance of screening children in high-risk groups, such as those born in countries endemic for HBV.
"Most children with chronic HBV infection are asymptomatic, lacking any signs or symptoms of disease," said Kathleen B. Schwarz, M.D., of Johns Hopkins University School of Medicine, panel member and a co-author of the report. Schwarz stressed, however, that "this is a progressive disease, and children infected chronically with HBV have an increased risk of severe complications as teens or adults, including cirrhosis, and even liver cancer. This is why screening and identification of HBV infection in children is essential."
A challenge facing pediatricians is the lack of clear screening, monitoring and treatment guidelines.