Université Catholique de Louvain, cliniques St Luc, Louvain, Belgium.
Incidence of chronic hepatitis B is declining thanks to universal immunization programs. Nevertheless, hepatitis B virus infection is still one of the most important causes of liver disease worldwide. An accurate knowledge of up-to-date pediatric epidemiologic data, prevalent transmission routes in childhood and available preventive measures is of primary importance to reduce the spread of the disease. Indeed, in spite of a rather benign course of chronic hepatitis B during childhood and adolescence, the lifetime risk of patients infected at birth to die because of liver disease is still too high. The natural history of the disease in childhood has been well described, together with the risks of rare but important complications such as hepatocarcinoma and cirrhosis. Few therapies have been licensed to treat chronic hepatitis B in children. Most are only partially effective, whereas sufficiently safe, and an accurate selection of subject to treat and of right timing for treatment is needed to optimize efficacy and reduce viral resistance. Newer drugs are extremely promising and their licensing for children could change management of pediatric chronic hepatitis B.