Recently, a Southeast Asian child who was adopted has come into my practice and they were found to be hepatitis B surface antigen (HBsAg) positive. What further screening tests should be done and how should this child be followed?
Hepatitis B is a very common infection in certain areas of the world. The prevalence may be as high as 30-40% in some Southeast Asian countries. Most individuals in those countries are infected by vertical transmission. More than 90% of children with vertical acquisition of hepatitis B progress to chronic infection with hepatitis B. Thus, it is very likely that this child was infected with hepatitis B at birth and has a chronic infection. In this setting, we recommend further testing to include a hepatitis B antigen (HBeAg) and anti-HBe antibody (HBeAB), and an hepatic profile to look for biochemical hepatitis, and an alpha fetoprotein. It is occasionally helpful to obtain an anti-HBcIgM to see if this is in an acute infection in which case the HBcIgM will be positive.
In the setting of chronic hepatitis B, the hepatitis B core IgM will be negative, while the HBsAg and often the HBeAg will be positive. In children and adults with chronic hepatitis B, there is an approximate 10% risk of the development chronic hepatitis (persistently elevated LFT’s for >6 months). There is also a significantly increased risk for the development of hepatocellular carcinoma. Minimal follow up should include: annual screening with a CBC, hepatic profile, alpha fetoprotein, HBeAg and anti-HBeAB. We recommend an abdominal ultrasound to screen for hepatocellular carcinoma every three years or sooner if the alpha fetoprotein is rising. These children should also receive the hepatitis A vaccine as should all children with chronic liver disease. The treatment and management of hepatitis B is a moving target and it is often helpful to obtain a consultation at a pediatric liver center for these children.