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Acute infectious hepatitis in hospitalised children: a British Paediatric Surveillance Unit study
  1. Serena Braccio1,2,
  2. Adam Irwin1,
  3. Andrew Riordan3,
  4. Delane Shingadia4,
  5. Deirdre A Kelly5,
  6. Sanjay Bansal6,
  7. Mary Ramsay2,
  8. Shamez N Ladhani1,2
  1. 1Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
  2. 2Immunisation Department, Public Health England, London, UK
  3. 3Paediatric Infectious Disease Department, Alder Hey Children's Hospital, Liverpool, UK
  4. 4Paediatric Infectious Disease Department, Great Ormond Street Hospital, London, UK
  5. 5Liver Unit, Birmingham Children's Hospital, Birmingham, UK
  6. 6Paediatric Hepatology Department, King's College Hospital, London, UK
  1. Correspondence to Dr Shamez Ladhani, Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; shamez.ladhani{at}phe.gov.uk

Abstract

Background Hepatitis remains a key public health priority globally. Most childhood cases are caused by viruses, especially hepatitis A virus (HAV) and hepatitis B virus (HBV). This study aimed to estimate the burden of acute infectious hepatitis in hospitalised children and to describe their clinical characteristics and outcomes.

Methods Paediatricians in the UK and Ireland reported cases in children aged 1 month to 14 years diagnosed between January 2014 and January 2015 (inclusive) through the British Paediatric Surveillance Unit (BPSU) and completed a detailed questionnaire. Additional HAV and HBV cases in England and Wales were identified through a national electronic database, LabBase2. All confirmed cases were followed up at 6 months with a second questionnaire.

Results The BPSU survey identified 69 children (annual incidence, 0.52/100 000), including 27 HAV (39%), three HBV (4%), 16 other viruses (23%) and 23 with no aetiology identified (33%). LabBase2 identified an additional 10 HAV and 2 HBV cases in England. Of the 37 hospitalised HAV cases, 70% had travelled abroad, but only 8% had been vaccinated. Similarly, three of the five children with acute HBV had not been immunised, despite being a household contact of a known infectious individual. All patients with HAV recovered uneventfully. In contrast, three children with acute HBV developed liver failure and two required liver transplantation.

Conclusions Acute infectious hepatitis is a rare cause of hospital admission. Most children recovered without complications, but those with acute HBV had severe presentations. At least three of the five HBV cases could have been prevented through appopriate vaccination of household contacts.

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Footnotes

  • Twitter Follow Adam Irwin @adamdirwin

  • Funding This investigator-led study was funded by GlaxoSmithKline SA. GlaxoSmithKline Biologicals SA was provided the opportunity to review and comment on the study protocol and a preliminary version of this manuscript for factual accuracy, but the authors are solely responsible for obtaining the appropriate approvals, conducting the study, collecting and analysing the data, as well as the final content and interpretation in the manuscript.

  • Competing interests None declared.

  • Ethics approval NRES Committee East of England––Cambridge Central (REC reference: 13/EE/0392; IRAS project ID: 114805).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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