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Chapter 17 - Hepatitis A and Hepatitis E Virus in Children

from Section III - Hepatitis and Immune Disorders

Published online by Cambridge University Press:  19 January 2021

By
Sara Kathryn Smith  and
Philip Rosenthal
Edited by
Frederick J. Suchy ,
Ronald J. Sokol  and
William F. Balistreri
Edited in association with
Jorge A. Bezerra ,
Cara L. Mack  and
Benjamin L. Shneider
Frederick J. Suchy
Affiliation:
University of Colorado, Children’s Hospital Colorado, Aurora
Ronald J. Sokol
Affiliation:
University of Colorado, Children’s Hospital Colorado, Aurora
William F. Balistreri
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati
Jorge A. Bezerra
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati
Cara L. Mack
Affiliation:
University of Colorado, Children’s Hospital Colorado, Aurora
Benjamin L. Shneider
Affiliation:
Texas Children’s Hospital, Houston
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Summary

Optimal care of children with viral hepatitis necessitates incorporation of recent advances in diagnosis, prevention, and treatment into clinical practice. Although primary viral infection of the liver has been recognized since the time of Hippocrates (460–375 BC), only since the early 1990s have significant scientific advancements allowed clinicians to alter the outcomes of these infections.

Type
Chapter
Information
Liver Disease in Children , pp. 273 - 284
Publisher: Cambridge University Press
Print publication year: 2021

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References

Rezende, G, Roque-Afonso, AM, Samuel, D, et al. Viral and clinical factors associated with the fulminant course of hepatitis A infection. Hepatology 2003;38:613–18.CrossRefGoogle ScholarPubMed
Robertson, BH, Jansen, RW, Khanna, B, et al. Genetic relatedness of hepatitis A virus strains recovered from different geographical regions. J Gen Virol 1992;73:1365–77.Google Scholar
Fujiwara, K, Yokosuka, O, Fukai, K, et al. Analysis of full-length hepatitis A virus genome in sera from patients with fulminant and self-limited acute type A hepatitis. J Hepatol 2001;35:112–19.CrossRefGoogle ScholarPubMed
Taylor, GM, Goldin, RD, Karayiannis, P, et al. In situ hybridization studies in hepatitis A infection. Hepatology 1992;16:642–8.Google Scholar
Ticehurst, JR, Racaniello, VR, Baroudy, BM, et al. Molecular cloning and characterization of hepatitis A virus cDNA. Proc Natl Acad Sci USA 1983;80:5885–9.Google Scholar
Koff, RS. Hepatitis, A. Lancet 1998;351:1643–9.Google Scholar
Craig, AS, Schaffner, W. Prevention of hepatitis A with the hepatitis A vaccine. N Engl J Med 2004;350:476–81.Google Scholar
Nelson, N. Hepatitis, A outbreaks. Presented at: Advisory Committee on Immunization Practices; October 25, 2017; Atlanta, GA. Available at: www.mdedge.com/familymedicine/article/155079/vaccines/cdc-provides-advice-recent-hepatitis-outbreaks [last accessed June 12, 2020].Google Scholar
Centers for Disease Control and Prevention. Hepatitis Surveillance Report 59. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2004:1–60.Google Scholar
Centers for Disease Control and Prevention. Hepatitis A outbreak associated with green onions at a restaurant – Monaca, Pennsylvania, MMWR Morb Mortal Wkly Rep 2003;52:1155–7.Google Scholar
Wheeler, C, Vogt, TM, Armstrong, GL, et al. An outbreak of hepatitis A associated with green onions. N Engl J Med 2005;353:890–7.Google Scholar
Hutin, YJF, Pool, V, Cramer, EH, et al. A multistate, foodborne outbreak of hepatitis A. N Engl J Med 1999;340:595–602.Google Scholar
Weinberg, M, Hopkins, J, Farrington, L, et al. Hepatitis A in Hispanic children who live along the United States– Mexico border: the role of international travel and food-borne exposures. Pediatrics 2004;114:e68–73.Google Scholar
Hadler, SC, Erben, JJ, Francis, DP, et al. Risk factors for hepatitis A in day-care centers. J Infect Dis 1982;145:255–61.CrossRefGoogle ScholarPubMed
Benenson, MW, Takafuji, ET, Bancroft, WH, et al. A military community outbreak of hepatitis type A related to transmission in a child care facility. Am J Epidemiol 1980;112:471–81.Google Scholar
Vernon, AA, Schable, C, Francis, D. A large outbreak of hepatitis A in a daycare center: association with non-toilet-trained children and persistence of IgM antibody to hepatitis A virus. Am J Epidemiol 1982;115:325–31.Google Scholar
Hadler, SC, Webster, HM, Erber, JJ, et al. Hepatitis A in day care centers: a community-wide assessment. N Engl J Med 1980;302:1222–7.Google Scholar
Centers for Disease Control and Prevention. Viral hepatitis outbreaks. Atlanta, GA: Centers for Disease Control and Prevention 2019. Available at: www.cdc.gov/hepatitis/outbreaks/hepatitisaoutbreaks.htm [last accessed June 12, 2020].Google Scholar
Balistreri, WF. Viral hepatitis. Emerg Clin North Am 1991;9:365–99.Google Scholar
Leach, C. Hepatitis A in the United States. Pediatr Infect Dis J 2004;23:551–2.Google Scholar
Jung, YM, Park, SJ, Kim, JS, et al. Atypical manifestations of hepatitis A infection: a prospective, multicenter study in Korea. J Med Virol 2010;82:1318–26.CrossRefGoogle ScholarPubMed
Rachima, CM, Cohen, E, Garty, M. Acute hepatitis A: combination of relapsing and the cholestatic forms, two rare variants. Am J Med Sci 2000;319: 417–19.Google Scholar
Schiff, ER. Atypical clinical manifestations of hepatitis A. Vaccine 1992;10(Suppl1):S18–S20.CrossRefGoogle ScholarPubMed
Ozcay, F, Canan, O, Akcan, B, et al. Hepatitis A super infection as a cause of liver failure in a child with Wilson’s disease. Turk J Pediatr 2007;49:199–202.Google Scholar
Ciocca, M, Moreira-Silva, SF, Alegria, S, et al. Hepatitis A as an etiologic agent of acute liver failure in Latin America. Pediatr Infect Dis J 2007;26:711–15.Google Scholar
Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1999;48:1–39.Google Scholar
Kim, HY, Eyheramonho, MB, Pichavant, M, et al. A polymorphism in TIM1 is associated with susceptibility to severe hepatitis A virus infection in humans. J Clin Invest 2011;121:1111–18.CrossRefGoogle ScholarPubMed
Arora, NK, Mathur, P, Ahuja, A, Oberoi, A. Acute liver failure. Indian J Pediatr 2003;70:73–9.CrossRefGoogle ScholarPubMed
Amon, JJ, Darling, N, Fiore, AE, et al. Factors associated with hepatitis A vaccination among children 24 to 35 months of age: United States, 2003. Pediatrics 2006;117:30–3.Google Scholar
Centers for Disease Control and Prevention. Vaccines and Immunizations. Atlanta, GA: Centers for Disease Control and Prevention 2019. Available at: www.cdc.gov/vaccines [last accessed June 12, 2020].Google Scholar
Centers for Disease Control and Prevention. Vaccine Recommendations of the Advisory Committee for Immunization Practices. Atlanta, GA: Centers for Disease Control and Prevention 2019. Available at: www.cdc.gov/vaccines/pubs/ACIP-list.htm [last accessed June 12, 2019].Google Scholar
Landry, P, Tremblay, S, Darioli, R, Genton, B. Inactivated hepatitis vaccine booster given 24 months after the primary doses. Vaccine 2000;19:399–402.CrossRefGoogle Scholar
McMahon, BJ, Williams, J, Bulkow, L, et al. Immunogenicity of an inactivated hepatitis A vaccine in Alaska native children and native and non-native adults. J Infect Dis 1995;17:676–9.Google Scholar
Horng, YC, Chang, MH, Lee, CY, et al. Safety and immunogenicity of hepatitis A vaccine in healthy children. Pediatr Infect Dis J 1993;12:359–62.Google Scholar
Balcarek, KB, Bagley, MR, Pass, RF, Schiff, ER, Krause, DS. Safety and immunogenicity of an inactivated hepatitis A vaccine in preschool children. J Infect Dis 1995;171(Suppl1): S70–S72.CrossRefGoogle ScholarPubMed
Ashur, Y, Adler, R, Rowe, M, Shouval, D. Comparison of immunogenicity of two hepatitis A vaccines – VAQTA and HAVRIX – in young adults. Vaccine 1999;17:2290–6.Google Scholar
Letson, GW, Shapiro, CN, Kuehn, D, et al. Effect of maternal antibody on immunogenicity of hepatitis A vaccine in infants. J Pediatr 2004;144:327–32.Google Scholar
Das, A. An economic analysis of different strategies of immunization against hepatitis A virus in developed countries. Hepatology 1999;29:548–52.Google Scholar
Werzberger, A, Mensch, B, Kuter, B, et al. A controlled trial of a formalin-inactivated hepatitis A vaccine in healthy children. N Engl J Med 1992;327:453–7.Google Scholar
Innis, BL, Snithhan, R, Kunasol, P, et al. Protection against hepatitis A by an inactivated vaccine. JAMA 1994;271:1328–34.Google Scholar
Gouvea, AF, De Moraes-pinto, MI, Ono, E, et al. Immunogenicity and tolerability of hepatitis A vaccine in HIV-infected children. Clin Infect Dis 2005;41:544–8.CrossRefGoogle ScholarPubMed
Siberry, GK, Coller, RJ, Henkle, E, et al. Antibody response to hepatitis A immunization among human immunodeficiency virus-infected children and adolescents. Pediatr Infect Dis J 2008;27:465–8.Google Scholar
Weinberg, A, Gona, P, Nachman, SA, et al. Antibody-response to hepatitis A virus vaccine in HIV-infected children with evidence of immunologic reconstitution while receiving highly active retroviral therapy. J Infect Dis 2006;193:302–11.Google Scholar
Arslan, M, Wiesner, RH, Poterucha, JJ, Zein, NN. Safety and efficacy of hepatitis A vaccination in liver transplantation recipients. Transplantation 2001;72:272–6.CrossRefGoogle ScholarPubMed
Diana, A, Posfay-Barbe, KM, Belli, DC, Siegrist, CA. Vaccine-induced immunity in children after orthotopic liver transplantation: a 12-yr review of the Swiss national reference center. Pediatr Transplant 2007;11:31–7.Google Scholar
Lee, SD, Chan, CY, Yu, MI, et al. Safety and immunogenicity of inactivated hepatitis A vaccine in patients with chronic liver disease. J Med Virol 1997;52:215–18.Google Scholar
Keeffe, EB, Iwarson, S, McMahon, BJ, et al. Safety and immunogenicity of hepatitis A vaccine in patients with chronic liver disease. Hepatology 1998;27:881–6.Google Scholar
Ferreira, CT, da Silviera, TR, Viera, SM, et al. Immunogenicity and safety of hepatitis A vaccine in children with chronic liver disease. J Pediatr Gastroenterol Nutr 2003;37:258–61.Google Scholar
El-Karaksy, HM, El-Hawary, MI, El- koofy, NM, et al. Safety and efficacy of hepatitis A vaccine in children with chronic liver disease. World J Gastroenterol 2006;12:7337–40.Google Scholar
Majda-Stanislawska, E, Bednarek, M, Kuydowicz, J. Immunogenicity of inactivated hepatitis A vaccine in children with chronic liver disease. Pediatr Infect Dis J 2004;23:571–4.CrossRefGoogle ScholarPubMed
Troisi, CL, Hollinger, FB, Krause, DS, et al. Immunization of seronegative infants with hepatitis A vaccine (HAVRIX®; SKB): a comparative study of two dosing schedules. Vaccine 1997;15:1613–17.CrossRefGoogle ScholarPubMed
Piazza, M, Safary, A, Vegnente, A, et al. Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination programme. Vaccine 1999;17:585–8.Google Scholar
Dagan, R, Amir, J, Mijalovsky, A, et al. Immunization against hepatitis A in the first year of life: priming despite the presence of maternal antibody. Pediatr Infect Dis J 2000;19:1045–52.Google Scholar
Fiore, AE, Shapiro, CN, Sabin, K, et al. Hepatitis A vaccination of infants: effect of maternal antibody status on antibody persistence and response to a booster dose. Pediatr Infect Dis J 2003;22:354–9.CrossRefGoogle ScholarPubMed
Hammitt, LL, Bulkow, L, Hennessy, TW, et al. Persistence of antibody to hepatitis A virus 10 years after vaccination among children and adults. J Infect Dis 2008;198:1776–82.Google Scholar
Werzberger, A, Mensch, B, Nalin, DR, Kuter, BJ. Effectiveness of hepatitis A vaccine in a former frequently affected community: 9 years’ follow-up after the Monroe field trial of VAQTA. Vaccine 2002;20:1699–1701.Google Scholar
Chang, CY, Lee, SD, Yu, MI, et al. Long-term follow-up of hepatitis A vaccination in children. Vaccine 1999;17:369–72.Google Scholar
Van Damme, P, Banatvala, J, Fay, O, et al. Hepatitis A booster vaccination: is there a need? Lancet 2003;362:1065–71.Google Scholar
Van Herckk, K, Van Damme, P. Inactivated hepatitis A vaccine-induced antibodies: follow-up and estimates of long-term persistence. J Med Virol 2001;63:1–7.Google Scholar
Centers for Disease Control and Prevention. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2006;55(RR-7):1–23.Google Scholar
Rosenthal, P. Cost-effectiveness of hepatitis A vaccination in children, adolescents, and adults. Hepatology 2003;37:44–51.Google Scholar
Ansari, IH, Nanda, SK, Durgapal, H, et al. Cloning sequencing, and expression of the hepatitis E virus (HEV) nonstructural open reading frame 1. J Med Virol 2000;60:275–83.Google Scholar
Krawczynski, K, Aggarwal, R, Kamili, S. Infections of the liver. Infect Dis Clin N Am 2000;14:1–18.Google Scholar
Worm, HC, van der Poel, WHM, Brandstatter, G. Hepatitis E: an overview. Microbes Infect 2002;4:657–66.Google Scholar
Aggarwal, R, Krawczynski, K. Hepatitis E: an overview and recent advances in clinical and laboratory research. J Gastroenterol Hepatol 2000;15:9–20.Google Scholar
Ahn, J-M, Kang, S-G, Lee, D-Y, et al. Identification of novel human hepatitis E virus (HEV) isolates and determination of the seroprevalence of HEV in Korea. J Clin Microbiol 2005;3042–8. Doi: 10.1128/JCM.43.7.3042-3048.2005Google Scholar
Tam, AW, Smith, MM, Guerra, ME, et al. Hepatitis E virus (HEV): molecular cloning and sequencing of the full-length viral genome. Virology 1991;185:120–31.Google Scholar
Reyes, GR, Purdy, MA, Kim, JP, et al. Isolation of a cDNA from the virus responsible for enterically transmitted non-A, non-B hepatitis. Science 1990;247:1335–9.Google Scholar
Shrestha, SM, Srestha, S, Tsuda, F, et al. Genetic changes in hepatitis E virus of subtype 1a in patients with sporadic acute hepatitis E in Kathmandu, Nepal, from 1997 to 2002. J Gen Virol 2004;85:97–104.Google Scholar
Mansuy, JM, Peron, JM, Abravanel, F, et al. Hepatitis E in the south west of France in individuals who have never visited an endemic area. J Med Virol 2004;74:419–24.CrossRefGoogle ScholarPubMed
Redlinger, T, O’Rourke, K, Nickey, L, Martinez, G. Elevated hepatitis A and E seroprevalence rates in a Texas/Mexico border community. Tex Med 1998;94:68–71.Google Scholar
Aggarwal, R, Naik, SR. Faecal excretion of hepatitis-E virus. Lancet 1992;340:787.Google Scholar
DeCock, KM, Bradley, DW, Sandford, NL, et al. Epidemic non-A, non-B hepatitis in patients from Pakistan. Ann Intern Med 1987;106:227–30.Google Scholar
Ray, R, Aggarwal, R, Salunke, PN, et al. Hepatitis E virus genome in stools of hepatitis patients during large epidemic in North India. Lancet 1991;338:783–4.Google Scholar
Skidmore, SJ, Yarbough, PO, Gabor, KA, et al. Hepatitis E virus: the cause of waterborne hepatitis outbreak. J Med Virol 1992;37:58–60.Google Scholar
Ticehurst, J, Popkin, TJ, Bryan, JP, et al. Association of hepatitis E virus with an outbreak of hepatitis in Pakistan: serologic responses and pattern of virus excretion. J Med Virol 1992;36:84–92.Google Scholar
Chauhan, A, Dilawari, JB, Jameel, S, et al. Common etiological agent for epidemic and sporadic non-A non-B hepatitis. Lancet 1992;339:1509–10Google Scholar
Hau, CH, Hien, TT, Tien, NT, et al. Prevalence of enteric hepatitis A and E viruses in the Mekong delta region of Vietnam. Am J Trop Med Hyg 1998;60:277–80.Google Scholar
Goto, K, Ito, K, Sugiura, T, et al. Prevalence of hepatitis E virus infection in Japanese children. J Pediatr Gastroenterol Nutr 2005;42:89–92.Google Scholar
Emerson, SU, Purcell, RH. Running like water: the omnipresence of hepatitis E. N Engl J Med 2004;351: 2367–8.Google Scholar
Bader, TF, Krawczynski, K, Polish, LB, et al. Hepatitis E in a US traveler to Mexico. N Engl J Med 1991;325:1659.Google Scholar
De Groen, PC. Hepatitis E in the United States: a case of “hog fever?” Mayo Clin Proc 1997;72:1197–8.Google Scholar
Goldsmith, R, Yarbough, PO, Reyes, GR, et al. Enzyme-linked immunosorbent assay for diagnosis of acute sporadic hepatitis E in Egyptian children. Lancet 1992;339:328–32.Google Scholar
Hyams, KC, Purdy, MA, Kaur, M, et al. Acute sporadic hepatitis E in Sudanese children: analysis based on a new Western blot assay. J Infect Dis 1992;165:1001–5.Google Scholar
Daniel, HDJ, Warier, A, Abraham, P, Sridharan, G. Age-wise exposure rates to hepatitis E virus in a southern Indian patient population without liver disease. Am J Top Med Hyg 2004;71:675–8.Google Scholar
Khuroo, MS, Kamili, S, Yattoo, GN. Hepatitis E virus infection may be transmitted through blood transfusions in an endemic area. J Gastroenterol Hepatol 2004;19:778–84.CrossRefGoogle Scholar
Singh, S, Mohanty, A, Joshi, YK, et al. Mother-to-child transmission of hepatitis E virus infection. Indian J Pediatr 2003;70:37–9, 597.Google Scholar
Khuroo, MS, Kamili, S, Jameel, S. Vertical transmission of hepatitis E virus. Lancet 1995;345:1025–6.Google Scholar
Kumar, RM, Uduman, S, Rana, S, et al. Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates. Eur J Obstet Gynecol Reprod Biol 2001;100:9–15.Google Scholar
Arora, NK, Panda, SK, Nanda, SK, et al. Hepatitis E infection in children: study of an outbreak. J Gastroenterol Hepatol 1999;14:572–7.Google Scholar
Worm, HC, van der Poel, WHM, Brandstatter, G. Hepatitis E: an overview. Microbes Infect 2002;4:657–66.CrossRefGoogle ScholarPubMed
Panda, SK, Jameel, S. Hepatitis E virus: from epidemiology to molecular biology. Viral Hepat 1997;3:227–51.Google Scholar
Kamar, N, Mansuy, JM, Cointault, O, et al. Hepatitis E virus-related cirrhosis in kidney- and kidney-pancreas-transplant recipients. Am J Transplant 2008;8:1744–8.CrossRefGoogle ScholarPubMed
Kamar, N, Garrouste, C, Haagsma, EB, et al. Factors associated with chronic hepatitis in patients with hepatitis E virus infection who have received solid organ transplants. Gastroenterology 2011;140:1481–9.Google Scholar
Legrand-Abravanel, F, Kamar, N, Sandres-Saune, K, et al. Hepatitis E virus infection without reactivation in solid-organ transplant recipients, France. Emerg Infect Dis 2011;17:30.Google Scholar
Hamid, SS, Atiq, M, Shehzad, F, et al. Hepatitis E virus superinfection in patients with chronic liver disease. Hepatology 2002;36:474–8.Google Scholar
Kumar, A, Aggarwal, R, Naik, SR, et al. Hepatitis E virus is responsible for decompensation of chronic liver disease in an endemic region. Indian J Gastroenterol 2004;23:59–62.Google Scholar
Ramachandran, J, Eapen, CE, Kang, G, et al. Hepatitis E superinfection produces severe decompensation in patients with chronic liver disease. J Gastroenterol Hepatol 2004;19:134–8.Google Scholar
Davern, TJ, Chalasani, N, Fontana, RJ, et al. Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology 2011;14:1665–72.Google Scholar
Bryan, JP, Tsarev, SA, Iqbal, M, et al. Epidemic hepatitis E in Pakistan: patterns of serologic response and evidence that antibody to hepatitis E virus protects against disease. J Infect Dis 1994;170:517.Google Scholar
Bile, K, Isse, A, Mohamud, O, et al. Contrasting roles of rivers and wells as sources of drinking water on attack and fatality rates in a hepatitis E epidemic in Somalia. Am J Trop Med Hyg 1994;51:466–74.CrossRefGoogle Scholar
Corwin, AL, Khiem, HB, Clayson, ET, et al. A waterborne outbreak of hepatitis E virus transmission in southwestern Vietnam. Am J Trop Med Hyg 1996;54:559–62.Google Scholar
Khuroo, MS, Dar, MY. Hepatitis E: evidence for person-to-person transmission and inability of low dose immune serum globulin from an Indian source to prevent it. Indian J Gastroenterol 1992;3:113–16.Google Scholar
Tsarev, SA, Tsareva, TS, Emerson, SU, et al. Successful passive and active immunization of cynomolgus monkeys against hepatitis E. Proc Natl Acad Sci USA 1994;91:10198–202.Google Scholar
Tsarev, SA, Tsareva, TS, Emerson, SU, et al. Recombinant vaccine against hepatitis E: dose response and protection against heterologous challenge. Vaccine 1997;15:1834–8.CrossRefGoogle ScholarPubMed
Kamili, S. Toward the development of a hepatitis E vaccine. Virus Res 2011;161:93–100.Google Scholar
Alric, L, Bonnet, D, Laurent, G, et al. Chronic hepatitis E virus infection: successful virologic response to pegylated interferon-alpha therapy. Ann Intern Med 2010;153:135–6.Google Scholar
Kamar, N, Rostaing, L, Abravanel, F, et al. Ribavirin therapy inhibits viral replication in patients with chronic hepatitis E virus infection. Gastroenterology 2010;139:1612–18.Google Scholar
Centers for Disease Control and Prevention. Viral hepatitis surveillance, United States, 2016. Atlanta, GA: Centers for Disease Control and Prevention 2016. Available at: www.cdc.gov/hepatitis/statistics/2016surveillance/pdfs/2016HepSurveillanceRpt.pdf [last accessed June 12, 2020].Google Scholar

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