Acute and chronic hepatitis: Working Group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition

The factors determining the natural history of hepatitis B virus (HBV) infection remain largely unclear, as do the rate of progression and the risk of cirrhosis and/or hepatoma. Clarification of these issues will give insight into the pathogenesis of HBV and the need for intervention. Greater effort is required to reduce the mother-to-infant transmission of hepatitis C virus (HCV) infection. Most cases of pediatric chronic hepatitis C are acquired by mother-to-infant transmission or through community-based exposure. There is a need to determine the incidence of mother-to-infant transmission, the factors favoring or interfering with this type of transmission, and methods to reduce the frequency.

Therapies for chronic viral hepatitis B are not yet satisfactory. Combination therapies for hepatitis C, which have improved treatment efficacy in adults, should be tested in clinical trials in children. Similarly, the cover-age rate and efficacy evaluation of viral hepatitis prevention is inadequate. Strategies of hepatitis A vaccination differ from country to country. Routine vaccination against hepatitis A in areas with high rates of infection or universal immunization depends on a cost-benefit evaluation (1). In this context, it is necessary to clarify issues of antibody persistence (time and levels) and the mechanisms that contribute to long-term protection (2). Moreover, training physicians and health workers to improve the efficacy of hepatitis prevention remains an important issue.

The global impact of hepatitis B vaccination on the prevention of complications needs to be elucidated. It is necessary to determine the long-term effects of the reduction of the incidence of fulminant, acute and chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC) to determine the cost-benefit of vaccination programs.