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We investigated whether we could applied the new "criteria of guideline for liver transplantation in patients with fulminant hepatic failure (FHF)" to children. Eight children with FHF were evaluated by new criteria at the onset of hepatic encephalopathy (day 0) and 5 days after encephalopathy (day 5), retrospectively. At day 0, only a patient who was received liver transplantation was predicted as dead accurately. At day 5, 4 patients alive without liver transplantation were judged as alive, and 3 patients received liver transplantation were judged as dead, accurately. New criteria permit accurate prognosis for children with FHF as well as adults. However, scoring according to new criteria should be evaluated sequentially, not only at day 0 in children.

In 1986, the Japanese government initiated a nationwide hepatitis B immunization program for infants born to HBV carrier mothers. We evaluated the long-term protective efficacy of this program. Total 105 children were vaccinated according to the schedule and we followed the levels of their serum HBs antibodies for over 4 years. Levels of their serum HBs antibodies were significantly declined at the age of 7 and older. But nobody showed evidence of HBV infection in this study period. This phenomenon is similar to those of other countries where universal vaccination have already been launched. In conclusion, long-term effectiveness of national vaccination program for mother to infant HBV infection is satisfactory and booster vaccination seems to be unnecessary at least until13 years old.

Since the national program of immunoprophylaxis against perinatal transmission of hepatitis B virus (HBV) was started in 1986, the HBV carrier rate in children was dramatically decreased. However, the cases of failure of the prevention still exist. In this study, we retrospectively analyzed the reasons of 56 cases of the failure of the prevention after the initiation of national program. Seventeen (31%) were not received the immunoprophylaxis of the national program by mistake. Seven (12%) were received the inappropriate doses of schedule. Our national program is relatively complicated compared to the method adopted by almost all other countries. Because of the universal vaccination program is easy to finish the schedule, we should consider converting our prevention schedule to the universal vaccination program.

We compared the international HB vaccine program with the Japanese HB vaccine program. A good responder was defined as having 100 mIU/ml or more of serum HBs antibodies. Eighty-one children were protected according to the international schedule and 60 children were treated with the Japanese schedule. The levels of serum HBs antibodies in children treated with the Japanese schedule were significantly higher than that in children treated with the international schedule one month after the 3rd vaccination and one year after birth. However, there was no significant difference in the proportion of good responders between the two schedules. In conclusion, the international HB vaccine program was as effective as the Japanese HB vaccine program.

Thirteen Japanese children and young adults (age range 10-40 years, median 18 years) with chronic hepatitis C have been treated with pegylated interferon α2b and ribavirin combination therapy in our pediatric center. The HCV RNA levels before treatment were 5-3,900 KIU/ml (median 1,500 KIU/ml), with HCV genotype 1 in 7 patients, 2a in 5, and 2b in 1. Of the 13 patients, 8 have completed the treatment course with sufficient follow-up to date, and 7 (with HCV genotype 1b in 4, 2a in 2 and 2b in 1) of them (88%) have achieved sustained virological response. The major adverse effect related to therapy was fever. This combination therapy was well tolerated in all the patients without cessation of the therapy. Our present results encourage treatment of pediatric hepatitis C patients with pegylated interferon and ribavirin, as in adult patients.

インターフェロン (IFN) 療法に抵抗し, 特異的な抗体反応を示したC型慢性肝炎の1例を経験した. 症例は18歳の女性で, 15歳時に急性リンパ性白血病と診断され, 寛解導入および末梢血幹細胞移植時に頻回に輸血を受けた. その頃よりトランスアミナーゼ値の多峰性の変動がみられ, C型慢性肝炎と診断し, 白血病の完全寛解後にIFN療法を行った. しかし, IFN投与中および投与終了後もトランスアミナーゼ値は正常化せず, HCV-RNA量も全く減少しなかった. 本例ではHCV抗体の産生能が低く, この免疫異常がIFN療法に影響を与えた可能性がある.

B型肝炎ウイルス(HBV)の持続感染小児においては,肝細胞障害の指標として組織所見の他には満足すべきものがない.今回我々はIgA型HBc抗体の肝細胞障害の指標としての有用性について検討した.47例の保存血清を対象にして検索したところ,IgA-HBc抗体は年齢,性別,HBe抗原/抗体の有無にかかわらず肝機能異常にほぼ相関しており,肝機能正常ののは低値であった.慢性肝炎例では肝機能が正常化するとともにIgA-HBc抗体は速やかに低下した.無症候性キャリアに発症したC型肝炎例では低値のまま不変であった.同一検体で検索したRIA法によるHBc抗体,IgA2-HBc抗体,分泌型IgA-HBc抗体はIgA-HBc抗体と相関したが,肝機能異常との関連はIgA1やIgA-HBc抗体よりも弱かった.IgA-HBc抗体はHBVによる肝機能障害の指標として特異性,感度とも高く,小児期のHBV感染の実態をさぐる上で有用と思われた.