Viral Hepatitis

Types of hepatitis viruses

There are six main types of the hepatitis virus that have been identified, including hepatitis A, B, C, D, E and G.

Hepatitis A

This type of hepatitis is usually spread by fecal-oral contact, or fecal-infected food and water and may also be spread by blood-borne infection (which is rare). The following is a list of modes of transmission for hepatitis A:

• Consuming food made by someone who touched infected feces.
• Drinking water that is contaminated by infected feces - a problem in developing countries with poor sewage removal.
• Touching infected person's feces (poop), which may occur with poor handwashing.
• Outbreaks may occur in child care centers especially when there are children in diapers.
• Residents of American Indian reservations or Native Alaskan villages where hepatitis A may be more common.
• International travel to areas where hepatitis A is common.
• Sexual contact with an infected person.
• Use of intravenous (IV) drugs.
• Blood transfusions (very rare).

• Vertical transmission (very rare).

A vaccine for hepatitis A has been developed and is now available. Because the vaccine is not given routinely, please consult your physician if you have questions about its use. The vaccine is recommended for the following children:

• Children living in areas of the country where the infection rate of hepatitis A is above the national average - according to the American Academy of Pediatrics, these states include: Arizona, Alaska, Oregon, New Mexico, Utah, Washington, Oklahoma, South Dakota, Idaho, Nevada and California. Children who live in other areas where there has been a community outbreak.
• Children who have a blood clotting disorder, such as hemophilia.
• Children who attend child care centers that have had outbreaks of hepatitis A.
• Children with chronic liver disease.

The Hepatitis A vaccine is not recommended for children under 1 year of age.

Hepatitis B

Hepatitis B has a wide range of clinical presentations. It can be mild, without symptoms, or it may cause chronic hepatitis. In some cases, when infants and young children acquire hepatitis B, they are at high risk for chronic liver disease and liver failure. Transmission of hepatitis B virus occurs through blood and body fluid exposure such as blood, semen, vaginal secretions or saliva. Infants may also develop the disease if they are born to a mother who has the virus. Infected children often spread the virus to other children if there is frequent contact (i.e., household contact) or a child has many scrapes or cuts. The following describes persons who are at risk for developing hepatitis B:

• Children born to mothers who have hepatitis B.
• Children who are born to mothers who have immigrated from a country where hepatitis B is widespread such as southeast Asia and China.
• Children who live in long-term care facilities or who are disabled.
• Children who live in households where another member is infected with the virus.
• Children who have a blood clotting disorder such as hemophilia and require blood products.
• Children who require dialysis for kidney failure.

• Adolescents who may participate in high-risk activities such as IV drug use, unprotected heterosexual or homosexual contact.  

A vaccine for Hepatitis B does exist and is now widely used for routine childhood immunization. Children currently receive the first vaccine between birth and 2 months, the second vaccine at 1 to 4 months and the third vaccine at 6 to 18 months. The vaccine is generally required for all children born on or after January 1, 1992, before they enter school. The vaccine is available for older children who may have not been immunized before 1992 and is recommended before age 11 or 12.

Hepatitis C

The symptoms of hepatitis C are usually mild and gradual. Children often show no symptoms at all. Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact or from an infected mother to her baby. Although hepatitis C has milder symptoms initially, it leads to chronic liver disease in a majority of people who are infected. According to the Centers for Disease Control, hepatitis C is the leading indication for liver transplantation in adults. With some cases of hepatitis C, no mode of transmission can be identified. The following describes persons who may be at risk for contracting hepatitis C:

• Children born to mothers who are infected with the virus.
• Persons who have a blood clotting disorder such as hemophilia and received clotting factors before 1987.
• Children who require dialysis for kidney failure.
• Individuals who received a blood transfusion before 1992.

• Adolescents who participate in high-risk activities such as IV drug use, unprotected heterosexual or homosexual contact.

There is no vaccine for hepatitis C. Persons who are at risk should be checked regularly for hepatitis C. Persons who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.

Hepatitis D

This form of hepatitis can only occur in the presence of hepatitis B. If a child has hepatitis B and does not show symptoms or shows very mild symptoms, infection with D can put that person at risk for liver failure that progresses rapidly. Hepatitis D can occur at the same time as the initial infection with B, or it may show up much later. Transmission of hepatitis D occurs the same way as hepatitis B, except the transmission from mother to baby is less common. Hepatitis D is rare in children born in the US due to the common use of hepatitis B vaccine in infancy.

Hepatitis E

This form of hepatitis is similar to hepatitis A. Transmission occurs through fecal-oral contamination. It is less common in children than hepatitis A. Hepatitis E is most common in poorly developed countries and rarely seen in the United States. There is no vaccine for hepatitis E at this time.

Hepatitis G

This is the newest strain of hepatitis and very little is known about it. Transmission is believed to occur through blood and is most commonly seen in IV drug users, individuals with clotting disorders such as hemophilia and individuals who require hemodialysis for renal failure. Often hepatitis G shows no clinical symptoms.

Symptoms

The following are the most common symptoms for hepatitis. However, each child may experience symptoms differently and some children may experience no symptoms at all.

Symptoms of acute (abrupt onset) hepatitis may include the following:

• Flu-like symptoms.
• Fever.
• Nausea or vomiting.
• Decreased appetite.
• Not feeling well all over.
• Abdominal pain or discomfort.
• Diarrhea.
• Joint pain.
• Sore muscles.
• Itchy red hives on skin.

Later symptoms include dark colored urine and jaundice (yellowing of the skin and eyes).

The symptoms of hepatitis may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Diagnosis

In addition to a complete medical history and examination by your physician, diagnostic procedures and other tests to determine the extent of the disease may include the following:

• Blood testing for the following:

  Liver function studies.

  Antibody studies (to check for hepatitis).

  Cellular blood counts.

  • Bleeding times

  • Electrolytes

  • Other chemicals in the body

• Liver biopsy - a small sample of liver tissue is obtained with a special biopsy needle and examined for abnormalities.
• Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, spleen and kidneys and to assess blood flow through various vessels.

Treatment of viral hepatitis

Treatment for viral hepatitis is provided in the Liver Disease Clinic, and is based on:

·         Your child's age, overall health and medical history.

·         Extent of the disease.

·         Your child's tolerance for specific medications, procedures or therapies.

·         Expectations for the course of the disease.

·         Your opinion or preference.

Treatment for hepatitis varies depending on the underlying cause of the disease. The goal of treatment is to stop damage to the liver and alleviate symptoms. Treatment may include one, or more, of the following:

·         Supportive care (healthy diet and rest).

·         Medications (to help control itching).

·         Maintaining adequate growth and development.

·         Avoiding alcohol and drugs.

·         Preventing the spread of the disease (if the cause is viral hepatitis).

·         Interferon drug therapy - a medication referred to as a "biologic response modifier" that can affect the immune system and has virus-fighting activities.

·         Frequent blood testing (to determine disease progression).

·         Hospitalization (may be required in more severe cases).

·         Liver transplantation (may be recommended for end-stage liver failure).

Prevention

Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventative measures include:

• Vaccinations - Vaccinations are available for hepatitis A and B.
• Blood transfusion - Blood transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.
• Antibody preparation - If a person has been exposed to hepatitis A or B, an antibody preparation (immunoglobulin) can be administered to help protect them from contracting the disease.