| Category | Hepatitis B/C |
Viral Hepatitis in Pediatric and adolescent:
The term hepatitis indicates inflammation/swelling of the liver. Viral hepatitis which is a major health care burden in India is caused by 4 major types of viruses – A, B, C, and E. below is a short overview regarding viral hepatitis in children and adolescents.
Hepatitis A: Hepatitis A virus (HAV) is the most common virus causing hepatitis in children. HAV is found in the stool and blood of infected persons and is responsible for sporadic and endemic cases of acute viral hepatitis in the developing world with sanitation and personal hygiene. The virus usually transmitted through the feco-oral route by ingestion of contaminated food or water. It also transmits from person to person contact with close contact with an infected person. Acute hepatitis in children and adolescents is mostly due to hepatitis A. In a small percentage of cases infected with this virus develop acute liver failure. In adults, hepatitis A is less common but disease severity and fatality are more.
Hepatitis E: Similar to hepatitis A, Hepatitis E is transmitted by fecal-oral route by ingestion of contaminated food and water and close contact with an infected person. Hepatitis E mostly infects adults and adolescents but it is less common in children. Like hepatitis A, hepatitis E also responsible for acute hepatitis (short-term disease) and rarely acute liver failure. It is one of the common causes of acute liver failure in pregnancy.
Hepatitis B and C: Hepatitis B and C viruses are less common in children than hepatitis A and E. They are common in adults and causes most chronic liver diseases and complications like cirrhosis and liver cancer. Hepatitis b and C are transmitted by parenteral routes - like needle injury, use of the contaminated needle, IV drug abuser, sexual route, and blood transfusion. In children, hepatitis b and c is mostly acquired during the perinatal period either by vertical route (through placenta from mother before the birth of the child) or during birth. Acute infection with hepatitis B can cause both acute and chronic diseases. Infection with hepatitis C mostly causes chronic disease in children and adolescents.
Manifestations: Patients with acute infection with hepatitis viruses (Hepatitis A, B, and E) manifests as fever, malaise, nausea, poor appetite, pain in the abdomen, and vomiting in the prodromal phase (lasted for initial 3 – 7 days). Following this patient suddenly developed jaundice (yellowish discoloration of eyes and urine) - icteric phase. Once jaundice appeared fever and other symptoms usually subside. This icteric phase persists for a variable time (days to weeks) and gradually subsides in most of the cases. Few patients with acute infection develop liver failure (acute liver failure) manifested as alteration of sensorium – like irrelevant talking, agitation, altered sleep cycle, drowsiness and unconsciousness, and bleeding.
Acute viral hepatitis in children below 2 - 5 years of age usually does not develop jaundice at all (anicteric hepatitis). They usually manifest as fever, pain abdomen, poor appetite, and vomiting. They need very high index suspicion for diagnosis.
Chronic hepatitis (hepatitis B and C) in children are usually asymptomatic. Commonly these two viruses are detected incidentally while the child is evaluated for some other reason. Rarely these viruses cause chronic liver disease like cirrhosis and liver tumor (hepatocellular carcinoma) in children and adolescents.
Diagnosis: Diagnosis of viral hepatitis needs a very high index of clinical suspicion especially in younger children. Blood tests (Liver function tests) show elevated liver enzymes and serum bilirubin. Confirmation of viruses is done by serological tests (for antibody and antigen depending and viruses) and PCR tests (Hepatitis B and C).
Treatment: Treatment of acute viral hepatitis is symptomatic. No specific antiviral is currently available against hepatitis A and E virus. Patients with acute viral hepatitis should take good nutrition and multivitamins etc. Parents have misconceptions about the restriction of diet for children with jaundice. They give only boiled rice and dal and glucose water and fruit juices to the children once they noticed jaundice. This practice is detrimental for the patients as this further decreases a child’s appetite and hence dietary intake. Patients need to be hospitalized in case of persistent vomiting, poor oral intake, altered sensorium, unconsciousness, and bleeding.
Hepatitis B and C are treated with antiviral drugs which are very effective. With the availability of highly effective antiviral medicines, hepatitis C is almost 98% curable.
Sometimes the patient needs liver transplantation when the patient develops acute liver failure, and complications of chronic liver disease (hepatitis B and c infection) like cirrhosis, the liver tumor which is usually in adults age ( after 40 years of age).
Prevention: As there is no antiviral drug against hepatitis A and E, prevention is the best strategy. Improvement of sanitation, personal hygiene, avoidance of contaminated food and water (street side foods) are the measures for prevention of hepatitis A and E viruses. Another effective measure is a vaccination which is available for hepatitis A. There is no vaccine against hepatitis E.
Hepatitis b and c can be prevented by avoiding the reuse or sharing of needles and safe sex practices, etc.
Prevention of perinatal transfer of hepatitis B: For prevention of perinatal transmission of hepatitis b to the baby is possible with the use of antiviral to the mother during the antenatal period and postnatal period. The baby of a hepatitis b positive mother should be vaccinated against hepatitis b within 12 hours of birth. With this strategy, the transmission of hepatitis b from mother to baby can be prevented in almost 95% of cases.
