Hung-Chang Lee

Universal screening for biliary atresia using an infant stool color card in Taiwan

Biliary atresia is the most common cause of death from liver disease in children. Although the Kasai operation before 60 days of age can significantly improve prognosis, delay in referral and surgery remains a formidable problem worldwide because of difficulties in differentiating it from benign prolonged neonatal jaundice. We established a universal screening system using an infant stool color card to promote the early diagnosis and treatment of biliary atresia. After a pilot regional study in 2002–2003, a national stool color screening system was established by integrating the infant stool color card into the child health booklet given to every neonate in Taiwan since 2004. Within 24 hours of the discovery of an abnormal stool color, this event is reported to the registry center. The annual incidence of biliary atresia per 10,000 live births in 2004 and 2005 was 1.85 (40/216,419) and 1.70 (35/205,854), respectively. The sensitivity of detecting biliary atresia using stool cards before 60 days of age was 72.5% in 2004, which improved to 97.1% in 2005. The national rate of the Kasai operation before 60 days of age increased from 60% in 2004 to 74.3% in 2005. The jaundice‐free rate (<2 mg/dL) at 3 months after the Kasai operation among infants with biliary atresia in 2004–2005 was 59.5% (44 of 74), significantly higher than the historical data of 37.0% in 1976–2000 before the stool card screening program (P = 0.002). Conclusion: Universal screening using the stool color cards can enhance earlier referral, which may ultimately lead to timely performance of the Kasai operation and better postoperative outcome in infants with biliary atresia. (HEPATOLOGY 2008.)

Screening for Biliary Atresia by Infant Stool Color Card in Taiwan

OBJECTIVE. We aimed to detect biliary atresia (BA) in early infancy to prevent additional liver damage because of the delay of referral and surgical treatment and to investigate the incidence rate of BA in Taiwan. METHODS. A pilot study to screen the stool color in infants for the early diagnosis of BA was undertaken from March 2002 to December 2003. We had designed an “infant stool color card” with 7 numbers of different color pictures and attached it to the child health booklet. Parents were then asked to observe their infants stool color by using this card. The medical staff would check the number that the parents chose according to their infants stool color at 1 month of age during the health checkup and then send the card back to the stool color card registry center. RESULTS. The average return rate was ∼65.2% (78184 infants). A total of 29 infants were diagnosed as having BA, and 26 were screened out by stool color card before 60 days of age. The sensitivity, specificity, and positive predictive value were 89.7%, 99.9%, and 28.6%, respectively. Seventeen (58.6%) infants with BA received a Kasai operation within 60-day age period. The estimated incidence of BA in screened newborns was 3.7 of 10000. CONCLUSIONS. The stool color card was a simple, efficient, and applicable mass screening method for early diagnosis and management of BA. The program can also help in estimating the incidence and creating a registry of these patients.

Pediatric fulminant hepatic failure in endemic areas of hepatitis B infection: 15 years after universal hepatitis B vaccination

To investigate the role of hepatitis B virus (HBV) infection in pediatric fulminant hepatic failure (FHF) after the launch of universal HBV vaccination, the authors analyzed the data from patients with FHF collected from a nationwide collaborative study group. Children aged 1 month to 15 years who were diagnosed with FHF (62 males and 33 females) between 1985–1999 were included. HBV infection (hepatitis B surface antigen [HBsAg] and/or immunoglobulin M hepatitis B core antibody [IgM anti‐HBc] seropositive) accounted for 46% (43 of 95 cases) of all the cases of FHF. The average annual incidence of FHF in the time period 1985–1999 was 0.053/100,000 in the group of patients ages 1–15 years and 1.29/100,000 in those patients age < 1 year. Approximately 61% (58 of 95 cases) of all FHF cases were infants. The percentage of HBV infection was found to be higher in infants (57%) compared with children ages 1–15 years (27%) (P = 0.004). The incidence rate ratio of those patients age < 1 year to those ages 1–15 years was 54.2 for HBV‐positive FHF and 15.2 for HBV‐negative FHF. Maternal HBsAg was found to be positive in 97% of the infants with HBV‐positive FHF, and hepatitis B e antigen (HBeAg) was found to be negative in 84% of these infants. Approximately 74% of all HBV‐positive FHF patients and 81% of the infantile HBV‐positive patients had been vaccinated. In conclusion, within the first 15 years of universal vaccination, HBV was found to rarely cause FHF in children age > 1 year but remained a significant cause of FHF in infants. HBV‐positive FHF was prone to develop in infants born to HBeAg‐negative, HBsAg‐carrier mothers; these infants had not received hepatitis B immunoglobulin according to the vaccination program in place. (HEPATOLOGY 2004;39:58–63.)

Decreasing Rate of Biliary Atresia in Taiwan: A Survey, 2004–2009

OBJECTIVES: The pathogenesis of biliary atresia (BA) is unclear, but epidemiological studies may help to elucidate possible causes. The goals of this study were to identify BA incidence changes in Taiwan in 2004–2009 and to survey the factors that might influence incidence changes to elucidate the possible causes of BA. METHODS: A Taiwan national registry system for BA has been established since 2004. By using data from the national registry system for BA, we identified BA incidence changes in 2004–2009. We also evaluated the correlations between BA incidences and estimated rotavirus vaccine coverage rates and between BA incidences and the gross domestic product. RESULTS: A total of 185 patients with BA were identified in 2004–2009 in Taiwan, whereas the number of live births was 1 221 189. Compared with the incidence of BA in 2004–2006 (1.79 cases per 10 000 live births), the incidence of BA in 2007–2009 (1.23 cases per 10 000 live births) was decreased significantly (P = .01). BA incidences were negatively correlated with the gross domestic product (P = .02) and marginally negatively correlated with rotavirus vaccine coverage rates (P = .07). CONCLUSIONS: A significant decrease in BA incidence in Taiwan since 2007 has been noted and may be related to improvements in the general socioeconomic status and the popularity of rotavirus vaccination. Although more evidence is needed to establish a direct correlation, this phenomenon may shed light on possible causes of and preventive interventions for BA.

Factors affecting the mortality of pediatric fulminant hepatic failure in relation to hepatitis B virus infection

Aim:u2002 To investigate the factors affecting the outcome of fulminant hepatic failure (FHF) in children in relation to hepatitis B virus (HBV) infection.

Identification of a novel HLA-B allele, B*460102, in three Taiwanese individuals

We here report a new human leukocyte antigen (HLA)-B allele, B*460102, which differs from B*460101 by synonymous substitution at the third nucleotide of codon 74 (GAC-->GAT) and independently found in three Taiwanese individuals.

Identification of the novel allele HLA‐B*51:84 by sequence‐based typing method in a Taiwanese individual

A new human leukocyte antigen-B allele, B*51:84 (B*5184), has been found in Taiwan. It differs from B*51:01:01(B*510101) by one nucleotide substitution at codon 145 (CGC →GGC), resulting to one amino acid change (Arginine to Glycine).

Identification of HLA-B*5410 in Taiwan

A new human leukocyte antigen-B allele, B*5410, has been detected in Taiwan. It has one nucleotide change from B*5401 at codon 156 (CTG-->CGG), resulting in one amino acid change (L-->R).

A novel HLA-DRB1 allele, DRB*090202, is identified in a Taiwanese family.

Human leukocyte antigen-DRB1*090202 has two synonymous nucleotide substitutions with DRB1*090201 at codons 57 and 58, which may be the result of a gene conversion.

A novel HLA‐DRB1 allele, DRB*1611, is identified in two Taiwanese individuals

Human leukocyte antigen (HLA)-DRB1*1611 has one nucleotide change at codon 14 (GAG-->AAG) from DRB1*160201, resulting in a coding change from Glu to Lys.