Cost-effectiveness of prescreening versus empirical vaccination for hepatitis A in Egyptian children with chronic liver disease

The aim of the study was to determine the prevalence of anti-hepatitis A virus [anti-HAV] antibodies among 172 children with chronic liver disease, and to calculate the cost- effectiveness of prescreening prior to hepatitis A vaccination. Anti-HAV antibodies were positive in 85.1%. However, seroprevalence of anti-HAV antibodies was 62.1% in children < 5 years and 94.4% in children 5+ years. We conclude that while it is cost-effective to do prescreening before hepatitis A vaccination for children with chronic liver disease aged 5+ years, prescreening might not be cost-effective in those aged < 5 years

Value of grayscale and duplex Doppler ultrasonography in the non-invasive assessment of children with chronic liver disease

Ultrasonograghy [US] has become an integral part of examination of the liver in many clinical settings. The aim of our study was to investigate the value of grayscale and duplex Doppler US in the non-invasive assessment of the abdominal morphological and portal hemodynamic changes in 25 Egyptian children with chronic liver disease [CLD] and to demonstrate any relationship with the etiology and "severity" of their disease. All patients had thorough interrogation, physical examination, laboratory investigations and percutaneous liver biopsy to diagnose the etiology and "severity" of their CLD. Thirteen patients had established cirrhosis and 12 had chronic hepatitis without cirrhosis After an overnight fast, abdominal grayscale and duplex Doppler US were carried out for all patients as well as 30 healthy, age and sex matched controls. Prominent caudate lobe was a constant US finding in all patients with cirrhosis. Thickened lesser amentum was present in 69.2% of cirrhotics in comparison to 33.3% of chronic hepatitis. Loss of the normal triphasic oscillation of the hepatic vein waveform was detected in 53.8% of cirrhotics in comparison to 8.3% of chronic hepatitics and none of the controls. Portal vein flow velocity was significantly lower in patients compared to controls and still significantly lower in cirrhotics than chronic hepatitics. Congestion index [CI] was significantly higher in the group with cirrhosis compared with both chronic hepatitis and control groups. Both portal vein flow velocity and CI showed significant negative correlation with portal vein diameter as well as with splenic size. Child-Pugh's staging of CLD showed a positive correlation with both abnormal hepatic vein waveform and abnormal direction of portal blood flow; also there was a powerful significant negative correlation with both hepatic vein and portal vein flow velocity but no correlations with the etiology of CLD. In conclusion, grayscale and duplex Doppler US can non-invasively detect significant morphological and portal hemodynamic changes in children with CLD. Some of these changes could be correlated with the stage or "severity" of liver disease rather than its etiology