Expert Panel of Pediatric Liver Specialists Publishes Recommendations for Monitoring and Referral of Children With Chronic Hepatitis B Infections

Expert Panel of Pediatric Liver Specialists Publishes Recommendations for
Monitoring and Referral of Children With Chronic Hepatitis B Infections

Improved monitoring for progression of disease in affected children is
essential

DOYLESTOWN, Pa., Oct. 5 /PRNewswire-USNewswire/ -- 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.

"There are several national and international guidelines available regarding
the management of adults with chronic HBV infection," said Brian McMahon,
M.D., of the Alaska Native Tribal Health Consortium, panel member and a
co-author of the report, "but guidelines for the treatment of children are
still evolving, in part because of the limited number of drugs that have been
studied in children so far. In the absence of guidelines, the best approach
for children is for the primary care physician and a pediatric liver
specialist to work in partnership to develop an individualized treatment plan
to manage this life-long chronic infection."

"Many children end up at a pediatric liver specialist as a result of parental
advocacy," Dr. Haber said. "There needs to be a greater focus on routinely
identifying and referring children with chronic HBV."

The panel's report provides recommendations for primary care providers on the
initial management of these children, including what tests to conduct to
periodically monitor disease progression, and when, based on the test results,
a pediatric liver specialist should be consulted. The report includes a flow
chart outlining the recommendations, which cover liver function testing,
hepatitis B serology and DNA levels, liver ultrasound, alpha-fetoprotein (AFP)
testing, and family history. The panel advocates for referral of any child
with elevated serum liver enzyme levels, elevated AFP levels, or a family
history of liver disease or liver cancer.

"The decision whether or not to treat needs to be evaluated carefully by a
pediatrician or specialist familiar with indications for treatment of chronic
HBV," Dr. Schwarz said. "The right treatment at the right time can enhance
quality and length of life. Inappropriate or unnecessary treatment can result
in the emergence of drug-resistant strains of the virus, potentially limiting
our treatment options for the future."

Reference
Haber, BA, et al. Recommendations for Screening, Monitoring and Referral of
Children with Chronic Hepatitis B in North America: Report of a Workshop.
Pediatrics published online Oct 5, 2009. (doi: 10.1542/peds.2009-0567)
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0567v1

About the Hepatitis B Foundation
The Hepatitis B Foundation is the only national nonprofit organization solely
dedicated to finding a cure and improving the quality of life for those
affected with hepatitis B worldwide through research, education and patient
advocacy. Visit www.hepb.org.

SOURCE Hepatitis B Foundation

Joan M. Block of Hepatitis B Foundation, +1-215-489-4900, joan@hepb.org