Epidemiologic Features of Chronic Viral Hepatitis B in Romania – The Experience of a Pediatrics Department

Background: Chronic viral hepatitis B is still a public health issue worldwide, although effective prophylaxis is available nowadays. Infection rate remains high in Romania; complete data is unavailable because a national reporting system is not implemented.

Objective: The authors aimed to analyze the epidemiology of viral hepatitis B infection in children admitted to the Pediatrics Department of „Grigore Alexandrescu” Children’s Hospital.

Methods: The study included 448 children with chronic viral hepatitis B. Epidemiological data was collected for all. Each patient underwent laboratory tests: transaminases, HBs and HBe antigens, viral load.
Results: Twenty percent of the patients were also positive for hepatitis D virus, and 1.6% for hepatitis C virus. Regarding the strain of hepatitis B virus, 74% were wild-type viral infections, while 26% were mutants. Sixty-seven percent of the patients had active viral hepatitis (high viral load and high transaminases); 15% were in an immune tolerant state (high viral load, but normal transaminases). Nine percent were healthy carriers (negative viral load and normal transaminases). The rest of 9% had hepatitis D virus, with negative viral B load, but high transaminases. In cases of negative HBe antigen viral infections (mutants), 55% had active viral hepatitis and 22% were in an immune tolerant state. The rest of 23% had hepatitis D virus infection, with negative viral B load, but high transaminases. Out of the wild-type hepatitis B viral infection, 13% patients were in an immune tolerance state, while 70% presented with active disease. The rest of 5% had negative viral load, but high transaminases, and 12% were healthy carriers.

Conclusion: Epidemiological assessment of pediatric patients with chronic viral hepatitis is necessary in Romania, due to lack of consistent data. Mutant viral strains were identified in a high proportion of patients. Most of the patients have active viral hepatitis and will require treatment.