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Epidemiology and Clinical Features of Childhood Chronic Hepatitis B Infection Diagnosed in England

Ladhani, Shamez N. MRCPCH, PhD*; Flood, Jessica S. MSc*; Amirthalingam, Gayatri FFPHM*; Mieli-Vergani, Giorgina PhD; Bansal, Sanjay MRCPCH; Davison, Suzanne MRCPCH; Naik, Sandhia PhD§; Riordan, Andrew FRCPCH; Shingadia, Delane FRCPCH; Tudor-Williams, Gareth MRCPCH**; Sira, Jaswant RCN††; Kelly, Deirdre A. FRCPCH††; Ramsay, Mary E. FFPHM*ChicB Participants

The Pediatric Infectious Disease Journal: February 2014 - Volume 33 - Issue 2 - p 130–135
doi: 10.1097/INF.0000000000000196
Original Studies

Background: This study aimed to estimate the prevalence of childhood chronic hepatitis B (CHB) infection diagnosed in England using capture-recapture analysis of 2 independent data sources and to describe the clinical and epidemiological characteristics, management, complications and outcome of children with CHB.

Methods: Pediatric specialists were contacted to report all CHB cases in children aged <16 years and complete a standardized questionnaire. Capture-recapture analysis of cases diagnosed during 2001–2009 using 2 independent data sources was performed to estimate the prevalence of childhood CHB.

Results: Capture-recapture analysis estimated 448 diagnosed CHB cases (prevalence, 4.6/100,000) in England, of whom only 44% had been referred for specialist follow up. Clinical information for 325 cases under specialist care revealed that half the cases (n = 164, 50%) had been born overseas, mainly Sub-Saharan Africa and Eastern Europe, whereas half the UK-born children were either Pakistani (25%) or Chinese (25%). Most children (n = 216, 66%) were asymptomatic, with only 60 (18.5%) ever receiving any antiviral therapy, although 2 developed cirrhosis in childhood and 1 hepatocellular carcinoma. Horizontal transmission among UK-born children was identified in only 3 children born since 2001, when universal antenatal hepatitis B virus screening was introduced. Most children born to antenatally diagnosed hepatitis B virus-positive mothers (49/51, 96%) had received at least 1 hepatitis B vaccine dose after birth.

Conclusions: In England, the prevalence of diagnosed childhood CHB is low, although the potential number of undiagnosed cases is difficult to estimate. Further efforts are required to strengthen the current antenatal screening program and newly diagnosed cases should be referred for specialist follow up.

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From the *Health Protection Agency; King’s College Hospital, Denmark Hill, London; Leeds Teaching Hospitals NHS Trust, Leeds; §Barts and the London Children’s Hospital, London; Alder Hey Children’s NHS Foundation Trust, Alder Hey Hospital, Liverpool; Great Ormond Street Hospital; **Imperial College, London; and ††Birmingham Children’s Hospital, Birmingham, UK.

Accepted for publication August 22, 2013.

ChicB participants are Katja Doerholt (St. George’s Hospital London), Stephen Hodges (Newcastle General Hospital), Christine Spray (Bristol Royal Hospital for Children), Maxine Brown (Birmingham Children’s Hospital) and Sarah Ann Tizzard (King’s College Hospital London)

S.N.L. has performed contract research for vaccine manufacturers on behalf of St. George’s University of London, but has received no personal remuneration. D.K. has received research grants and provided consultancy services for manufacturers of antivirals against hepatitis viruses. G.T.W. is the pediatric representative on the NICE Guideline Development Group for HBV management of adults and children. He is a PI for a Roche-sponsored multinational trial of pegylated interferon alpha in children with HBV infection.

This study was internally funded by the Health Protection Agency through its R&D PUMP-PRIMING & SMALL INITIATIVES FUND (PPSIF) program. The funding body had no role in the study design; in the collection, analysis or interpretation of data, in the writing of the report or in the decision to submit the article for publication. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Shamez N. Ladhani, MRCPCH, PhD, Health Protection Services Colindale, Immunisation, Hepatitis and Blood Safety Department, 61 Colindale Avenue, London NW9, 5EQ, United Kingdom. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.