Patterns of childhood hepatitis in the Nigerian African.

A total of 133 children aged between less than a month to 14 years presenting consecutively with hepatitis were prospectively studied over a 6-year period. Most cases were acute and presented at the icteric phase. The peak incidence was in very young infants whose illness had to be differentiated from congenital biliary tract obstruction. The older children exhibited the usual manifestations of lethargy, anorexia and tenderness over the liver area to varying degrees. There were 2 cases of chronic active hepatitis in children aged 13 and 14 years, one a female and the other a male. Their illness was controlled with steroid therapy. The serum biochemistry was characteristic in all cases. Serological tests revealed that about 55% of the children had antibody to hepatitis A virus but only 4% demonstrated HAV-specific IgM, while 15% had hepatitis B surface antigen (HBsAg) and 23% demonstrated antibody to core antigen (HBcAg). While most of the children with acute hepatitis made a full clinical and biochemical recovery, 2 have persistent HBs antigenaemia. There were 3 deaths in children who had fulminant hepatitis. Our results show that exposure to hepatitis A virus appears to be prevalent in Nigerian children and probably occurs quite early in life, and infections with hepatitis B virus and perhaps other hepatotropic viruses are also not uncommon. The surveillance of such children and long-term follow-up are necessary. There is already compelling evidence to indicate that hepatocellular carcinoma, prevalent among young adults in our environment, may be related to hepatitis B antigenaemia persisting over several years. The need for an effective vaccine against hepatitis B virus infection cannot, therefore, be over-emphasized.