Remington and Klein's Infectious Diseases of the Fetus and Newborn Infant, 9th Edition - Chapter 27: Hepatitis

Knowledge about the hepatotropic viruses has grown dramatically in the past century, with strong contributions from clinicians, molecular virologists, immunologists, and pharmacologists, particularly in the past decade. Here we present up-to-date clinical information on hepatotropic viruses including hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV) viruses as well as GB virus type C/hepatitis G virus (HGV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The incidence and health care costs related to HAV should decrease dramatically with the use of the highly effective hepatitis A vaccine for all subjects 1 to 18 years of age; universal vaccination for all adults, as well, may be a more practical strategy, rather than targeted immunization in high-risk groups. More effective strategies are needed to prevent maternal-to-fetal transmission of HBV because vaccine failures still occur in at least 10% of mother-infant pairs. New data have emerged in recent years on the natural history and treatment of chronic HBV infection in children, but antiviral resistance remains a main concern during long-term treatment of chronic HBV. For the last decade, several government and nongovernment organizations have held consensus conferences on the management of acute and chronic viral hepatitis to update previous management recommendations, in particular against HCV infection. Advances have been made in treatment of HCV in children, and promising results are seen with specifically targeted antiviral therapies. A novel hepatitis E vaccine was shown to be efficacious; however, more investigations to improve immunogenicity and safety are needed, especially for pregnant persons, in whom morbidity and mortality are high. More attention should be paid to disease burden associated with HEV, an emergent pathogen, especially in developing countries with low and middle incomes. Close observations of HGV and torque teno virus (TTV) are needed to see if these viruses are truly of clinical significance.