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The child is father of the man (William Wordsworth)
Among human hepatitis viruses, hepatitis B (HBV) and C (HCV) are able to persist in the host for years and principally contribute to the establishment of chronic hepatitis. A large number of people, worldwide, is still estimated to be infected with HBV and HCV: 370 and 130 million, respectively.1
In endemic areas, HBV infection is often acquired perinatally or early in childhood and becomes chronic in a high proportion of cases. Universal vaccination of newborns has been effective in reducing the spread of infection. However, hepatitis B is still a social–sanitary problem in undeveloped areas where immunisation policies are unavailable and in developed countries, where the reservoir of infection is maintained by immigration and adoption. In some endemic areas children with chronic hepatitis B are also at risk for superinfection with the hepatitis delta virus (HDV), which worsens the prognosis of liver disease.
In the absence of a specific vaccination, HCV infection remains a major global health problem. Although efficient therapies are now available, HCV-related end-stage liver disease is still the most frequent indication for liver transplantation in adult patients. The spread of HCV infection in childhood is much more limited,2 3 but vertical transmission, though of low efficiency, contributes to maintaining the reservoir of infection worldwide.4 Based on a projection model for paediatric HCV outcomes, it has been suggested that HCV infection will have a significant economic impact over the next 10 years.5
Indeed, chronic viral hepatitis acquired in childhood is a long-lasting process based on host–virus interactions, which may change over the years. A number of factors related to the virus (genotype, therapy), to the host (hormonal status, immunocompetence, therapy) and to the environment (alcohol, drugs, co-infections) can interfere with the natural history of the …