APPSPGHAN 2022

Anshu Srivastava

Professor, Department of Pediatric Gastroenterology Sanjay Gandhi Postgraduate

Institute of Medical Sciences

India

Qualification(s)
MD (Pediatrics), DM (Gastroenterology).
Fellowship Pediatric Gastroenterology and Hepatology at Royal Children’s Hospital, Melbourne, Australia and Alberta Children’s Hospital, Calgary, Canada

Area(s) of Interest
Autoimmune liver disease, Liver failure, Portal hypertension, Inflammatory bowel disease and motility disorders including achalasia

Publication(s)
~140 papers and 15 book chapters

Others
Section Editor (Gastroenterology) in Indian Journal of Pediatrics

Acute Viral Hepatitis: Experience From Asia

Liver Symposium (Day 2)

14 October 2022 (1500-1630) @ Sipadan Hall 2

Acute viral hepatitis (AVH) is a common problem in the Asia Pacific region with hepatitis A virus (HAV) infection being the most common in children, followed by hepatitis B (HBV) and E (HEV). Uncommon causes include EBV, Parvo, dengue , HCV, CMV and adeno virus infection. In the vast majority of children, AVH starts with a prodrome followed by jaundice which subsides in 4-6 weeks. Nearly 18-20% children may have co-infection with 2 viruses, mostly HAV and HEV, but that has not been shown to increase the risk of complications or poor outcome. Complete liver function test and viral serology (IgM anti-HAV, IgM anti-HEV, HBsAg and IgM anti-HBc) is usually done to confirm the diagnosis. Most children with AVH need only symptomatic therapy and follow-up until complete clinical and biochemical recovery. However, the following subgroups of cases need special attention-

Children at risk of developing acute liver failure (<1% of all AVH)- Patients with uncorrectable coagulopathy, shrinking liver span, irritability or altered sleep pattern etc. need to be identified early and hospitalized.
Children with atypical manifestations like relapsing AVH, cholestatic hepatitis, extra intestinal manifestations like pancreatitis, hemolysis, arthralgia, thrombocytopenia etc. These subjects need to be recognized and diagnosed correctly so as to avoid unnecessary investigations.
Children with underlying CLD- In nearly half of the cases of acute on chronic liver failure, the first clinical presentation is with acute onset jaundice due to AVH and the underlying CLD had been unrecognized. In all cases with suspected AVH, one should look for features of underlying CLD like early ascites, splenomegaly, growth failure, peripheral stigmata of CLD et. Appropriate evaluation, and prompt management of ACLF is required in them.
Children with other infections resembling/ co-existing with AVH like enteric fever, leptospirosis, scrub typhus etc. Persistence of fever despite appearance of jaundice, systemic features (rash, eschar, lymphadenopathy etc.) and investigations help in correct diagnosis. Appropriate antimicrobial treatment is essential for a good outcome in these cases.

Specific antivirals are recommended only in select situations like HBV related ALF, severe EBV, persistent chronic HEV despite reduced immunosuppression etc. These cases should be managed by pediatric hepatologists. Adequate sanitation, safe water supply, feco-oral hygiene, educating about zoonotic transmission for HEV, adequate screening of blood products and safe injection practices are the important measures for prevention of AVH. Effective vaccination is available against Hepatitis A and B, while HEV vaccine is still not available for routine use. WHO has set a target of elimination of viral hepatitis by 2030 and we have to actively work to achieve this.

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