Universal infant hepatitis B virus (HBV) vaccination program has shown its propitious effects in preventing HBV infection in vaccinated young generations. However, owing to high viral load with mild diseases and long-term effect of antivirals, management of chronically infected children still poses a significant challenges. 

Therefore, initiation of more potent antivirals approved for pediatric patients in chronically ill children can considerably improve their outcome.

The current update has considered natural history of chronic HBV infection, its management in children from the past to the present, current consensus on the treatment of chronic hepatitis B in children, disagreements in cessation of oral antiviral therapy, and management of special populations like pregnancy and co-infections.

The recent updates suggest that peginterferon is recommended for immune-active children ≥ 3 years old for prevention of hepatitis B. The children who are intolerant, decompensating or preferring oral therapy, first-line nucleostide analogs (NUC) such as Entecavir or Tenofovir, can be given for beneficial effects. Nevertheless, close monitoring and follow-ups are required for immune-tolerant or inactive carriers. More researches are required to assess the time to stop NUCs and novel therapies for the management of hepatitis B infection.

Sources: Expert Rev Gastroenterol Hepatol. 2019;13(11):1065-1076.