HCV in Kids

22 09 2006

What can parents expect for their children infected with HCV?  These are the results of one study that tries to answer that question:

Scientists from Great Britain recently studied the clinical course of HCV infection in 185 individuals who acquired their infections in childhood.  The median age of the group was 11.9 years.

Fifty-nine acquired HCV perinatally, sometime before or just after birth from the HCV+ birth mothers, and 78 had abnormal liver enzymes with 14 percent showing signs and symptoms of liver disease (hepatocellular carcinoma, varices, ascites, splenomegaly, hepatomegaly and spider naevi).  Eighty-four of the 95 liver biopsies taken showed abnormal histologies. 

It was found that the duration of the person’s infection and co-infections were associated with signs and symptoms of liver disease.

After adjusting for age, sex, duration of infection and underlying medical conditions, individuals with vertically acquired infections had a 5-fold increase in the odds of developing signs and symptoms of liver disease, compared with those acquiring their infections parenterally.

Of the 20 percent of patients who had received antiviral therapy, 52 percent of those achieved a sustained viral response.  The authors concluded that the clinical course of HCV infection in childhood is relatively benign but co-morbidities (diseases), longer duration of infection and vertical route of acquisition were all risk factors for HCV-related disease progression.



HBV Notes

21 09 2006

 I came across a couple of studies the other day and wanted to share this info with parents of HBV+ kids.  Here are my notes, with quite a bit of the text lifted from the reports:

Hepatitis B virus genotypes and how they might affect treatment and disease progression haven’t been studied much in kids and teens.  Stefan Wirth and colleagues investigated this question, studying a group of 249 children with an average age of 7 years. 

Ninety-six percent of the group had HBV genotypes A or D and the rest had genotypes B, C, E or F.  There seemed to be no significant difference in ALT levels (an enzyme released from liver cells, elevated numbers of which may indicate liver damage) or histological findings among the various genotypes.  (From PKIDs’ glossary, histology is sometimes called microscopic anatomy and focuses on the relationships of the minute structures of cells, tissue, and organs to their functions.)

However, children with HBV genotype D had very high hepatitis B virus DNA levels and tended to seroconvert to hepatitis B e antibody later than those with genotype A.

The scientists concluded that: children with HBV genotype D showed a significantly higher viral load as compared to patients with HBV genotype A.  Since children with vertical transmission and high viral replication respond significantly poorer to treatment, individuals with genotype D have to be monitored particularly careful.  Long-term studies need to clarify, whether these patients are prone to develop a more unfavorable outcome.

Maureen Jonas and colleagues at Boston Children’s reported on Histologic Features of Chronic Hepatitis B in Children.  They noted that chronic hepatitis B (CHB) is usually asymptomatic in children but may cause significant liver disease later in life.

Jonas evaluated liver biopsies from 76 children with CHB recorded between 1984 and 2004.  It’s unknown whether these children had other liver diseases at the time of the biopsy.  She looked at severity of inflammation, necroinflammatory activity and fibrosis. 

The report states that, at the time of biopsy, children were 1 to 19 years of age and 50 of the children were Asian, 15 Caucasian, six African or African American, and the race was not known in five.  All were seropositive for HBeAg.  Forty-two acquired HBV perinatally, four likely via blood transfusion, and the mode of acquisition was unknown in the rest.

All biopsies had evidence of chronic hepatitis.  Portal inflammation and necroinflammatory activity were generally mild.  All biopsies demonstrated some fibrosis. 

Portal plasma cells were present in 59 biopsies.  Two obese patients had coexisting steatohepatitis.  ALT values near the time of biopsy were available in 64 children.  The mean ALT was 154.2 IU/L

Weak positive associations between age and the stage of fibrosis and between ALT and fibrosis were seen.
The report concluded that children with CHB and abnormal ALT have a spectrum of hepatic histological findings.  Although most have mild inflammation and necroinflammatory activity, fibrosis is moderate to severe in more than half of children with CHB.  More than 35 percent of children in this review had either bridging fibrosis with lobular distortion or cirrhosis.  Older children and those with higher ALT tend to have greater degrees of fibrosis.

PKIDs’ note: A baseline biopsy, as is common for those infected with hepatitis C, may be warranted for children with CHB.



Virtual Connections

15 09 2006

I’m really excited about our new Virtual Connections offerings. Our goal is to provide fun and informative ways for people to get the information they want in a way that fits into their schedules, and to foster a greater sense of community among our families. Here’s the low-down on the Virtual Community features:

Blog – You’re reading it now! For anyone who received the PKIDs’ News mailing, the blog will fill that need – with the informative articles – and more, providing information about the organization’s activities and current events related to the topics we cover.

Live chats – We just launched two chat rooms: open and moderated. The open chat room will be for people to log into and chat with each other. This room will be open 24/7 for you to use at your convenience. The moderated chat room will be reserved for scheduled chats with guests and other experts. Our first moderated chat will be taking place November 14th with Phil Rosenthal, MD, as our guest. For more information on chats, please visit the live chats main page.

Newsfeeds – We’ve got four newsfeeds that feature current news articles on the following topics: Hepatitis, HIV/AIDS, Immunizations, and Infectious Diseases. We post new items a few times a week.

Let me pause to note that there’s more than one way to get our blog and newsfeed stuff. Choose the method that works best for you.

  1. You can subscribe to the blog and newsfeeds via email. For the blog’s email option, see the sidebar to the right. For the newsfeeds’ email options, see the newsfeed page.
  2. Subscribe to the blog or newsfeeds via RSS. If you’re not sure what that is, click here. If you’re still not sure, drop me a line.
  3. View them online by visiting the blog link or the links from the newsfeed page.

I highly recommend subscribing. That way, you automatically receive posts when they’re posted.

Podcasts – If you’d rather hear your news than read it, podcasts are for you. We haven’t got our podcasts up and running yet, but they’ll be as easy to hear and receive as the blog and newsfeeds. The podcasts will be MP3 files of interviews and such on various topics.

Listserv – As some of you know, we’ve offered a listserv for our parents for quite some time. We’ll continue to offer this, and in the future are considering forums as well. Forums are a great way to encourage community and support, just as our friendly listserv is doing.

I hope this paints a picture of our newest developments and the ones we’ve got in the works. As always, contact the office with any questions and suggestions!

PKIDs’ Updates

14 09 2006

Autumn always brings busy times to the office.  We’re continuing to update the Pediatric Hepatitis Report.  We’d hoped to have it all done by last spring, but it didn’t happen, although quite a bit has been updated.  We think it will all get done before the holidays.

As part of the Teen Vaccine Initiative, we’re working with a production company to make five videos for 18-24 year olds.  They’re funny and serve as reminders that vaccines are out there for this age group.  When the time is close for the unveiling of the masterpieces, we’ll release the URL and do a big media campaign.

PKIDs has been on the board of directors of the National Viral Hepatitis Roundtable since that organization’s inception.  I took over for another PKIDs parent who needed to resign for medical reasons and am now on the executive committee as vice-chair.  Molli Conti from the Hepatitis B Foundation is the chairperson and she, along with Dick Conlon, are keeping us moving. (http://www.nvhr.org/)  At some point, and probably soon, we’ll need to get off the board and make room for others.  For now we’re hanging in to represent the kids.  If you represent a pediatric organization, you might consider joining NVHR and running for the board during the next elections.

I’m on the National Vaccine Advisory Committee, which is part of NVPO (National Vaccine Program Office), which is part of the U.S. Dept. of Health and Human Services.  I’m the consumer rep on the committee.  They try to fit in one regular person to give the consumer’s viewpoint to goings-on?so for the next four years, that’s me.  If you have any vaccine-related opinions you’d like me to share or questions you’d like answered, let me know and I’ll pass them along.

We are fine-tuning an Infectious Disease Workshop that we’re going to market to the business community. 

We’re doing all sorts of virtual community work on our website.  Franji can better explain everything we’re doing and I’m sure she’ll be writing a blog entry to cover all that.

Other than the usual work of helping parents who call in and keeping up-to-date on the various issues that matter to the families and writing grant proposals and finding resources for folks and so on, I think I’ve hit on the highlights.  Feel free to call the office if you want to chat (877-557-5437) or email pkids@pkids.org


13 09 2006

Kids are back in school and signing up for sports. 

Some parents wonder about their infected children playing sports and possibly infecting others in the process.  Parents also wonder how concerned they should be about their children becoming infected from other players living with undiagnosed or undisclosed infections. 

We looked into this a while back and recently checked for updated information.  Here’s what we’ve discovered over the years:

Playing sports can be risky in many ways and part of that risk is the potential to become infected with all sorts of germs.

Parents of children living with diagnosed infectious diseases worry that they may be responsible for infecting another child.  They wonder if they should inform the coach or the school.  They worry that the adults in charge don’t really follow standard precautions, thereby increasing the risk of infections.  They want their kids to enjoy life and they want to do the right thing.

The American Academy of Pediatrics issued a policy statement on this dilemma in December, 1999: HIV and Other Blood-Borne Viral Pathogens in the Athletic Setting. In it, the Academy made clear, “Because of the low probability of transmission of their infection to other athletes, athletes infected with HIV, hepatitis B or hepatitis C should be allowed to participate in all sports.”

That participation, however, assumes all athletes and coaches will follow standard precautions to prevent and minimize exposure to blood-borne viruses.

There is no reason to exclude any student from sports if they’re infected with HIV, HBV or HCV.  Nor is there a reason to disclose the infection.  There are many people living with undiagnosed infections, so it is more prudent to ensure everyone is practicing standard precautions rather than simply excluding those with known infections and not properly protecting all athletes from undiagnosed infections.

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