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Hepatitis B - children

Silent infection - HBV children; Antivirals - hepatitis B children; HBV children; Pregnancy - hepatitis B children; Maternal transmission - hepatitis B children

Hepatitis B in children is swelling and inflamed tissue of the liver due to infection with the hepatitis B virus (HBV).

Other common hepatitis virus infections include hepatitis A and hepatitis C.

Causes

HBV is found in the blood or body fluids (semen, tears, or saliva) of an infected person. The virus is not present in the stool (feces).

A child can get HBV through contact with the blood or body fluids of a person who has the virus. Exposure can occur from:

  • A mother with HBV at the time of birth. It does not appear that HBV is passed to the fetus while still in the mother’s womb.
  • A bite from an infected person that breaks the skin.
  • Blood, saliva, or any other body fluid from an infected person that may touch a break or opening in a child’s skin, eyes, or mouth.
  • Sharing personal items, such as a toothbrush, with a someone who has the virus.
  • Being stuck with a needle after use by an HBV-infected person.

A child cannot get hepatitis B from hugging, kissing, coughing, or sneezing. Breast-feeding by a mother with hepatitis B is safe if the child is treated properly at the time of birth.

Teenagers who are not vaccinated can get HBV during unprotected sex or drug use.

Symptoms

Most children with hepatitis B have none or only a few symptoms. Children younger than 5 years rarely have symptoms of hepatitis B. Older children may develop symptoms 3 to 4 months after the virus enters the body. The main symptoms of a new or recent infection are:

  • Appetite loss
  • Fatigue
  • Low fever
  • Muscle and joint pain
  • Nausea and vomiting
  • Yellow skin and eyes (jaundice)
  • Dark urine

If the body is able to fight HBV, the symptoms end in a few weeks to 6 months. This is called acute hepatitis B. Acute hepatitis B does not cause any lasting problems.

Exams and Tests

Your child's health care provider will perform blood tests called the hepatitis viral panel. These tests can help diagnose:

  • A new infection (acute hepatitis B)
  • A chronic or long-term infection (chronic hepatitis B)
  • An infection that occurred in the past, but is no longer present

The following tests detect liver damage and the risk for liver cancer from chronic hepatitis B:

The provider will also check the viral load of HBV in the blood. This test shows how well your child's treatment is working.

Treatment

Acute hepatitis B does not need any special treatment. Your child's immune system will fight the disease. If there is no sign of the HBV infection after 6 months, then your child has recovered fully. However, while the virus is present, your child can pass the virus to others. You should take steps to help prevent the disease from spreading.

Chronic hepatitis B needs treatment. The goal of treatment is to relieve any symptoms, prevent the disease from spreading, and help prevent liver disease. Make sure that your child:

  • Gets plenty of rest
  • Drinks lots of fluids
  • Eats healthy foods

Your child's provider also may recommend antiviral medicines. The medicines decrease or remove HBV from the blood:

  • Interferon alpha-2b (Intron A) can be given to children age 1 and older.
  • Lamivudine (Epivir) and entecavir (Baraclude) are used in children age 2 and older.
  • Tenofovir (Viread) is given to children age 12 and older.

It is not always clear what medicines should be given. Children with chronic hepatitis B may get these medicines when:

  • Liver function quickly gets worse
  • The liver shows signs of long-term damage
  • HBV level is high in the blood

Outlook (Prognosis)

Many children are able to rid their body of the hepatitis B virus and do not have a long-term infection.

However, some children never get rid of HBV. This is called chronic hepatitis B infection.

  • Younger children are more prone to chronic hepatitis B.
  • These children do not feel sick, and lead a relatively healthy life. However, over time, they may develop symptoms of chronic liver damage.

Almost all newborns and about half of children who get hepatitis B develop the chronic condition. A positive blood test after 6 months confirms chronic hepatitis B. The disease will not affect your child’s growth and development. Regular monitoring plays an important role in managing the disease in children.

You should also help your child learn how to avoid spreading the disease now and into adulthood.

Possible Complications

The possible complications of hepatitis B include:

These complications generally occur during adulthood.

When to Contact a Medical Professional

Call your child's provider if:

  • Your child has symptoms of hepatitis B
  • Hepatitis B symptoms do not go away
  • New symptoms develop
  • The child belongs to a high-risk group for hepatitis B and has not had the HBV vaccine

Prevention

If a pregnant woman has acute or chronic hepatitis B, these steps are taken to prevent the virus from being transmitted to a baby at birth:

  • Newborn babies should receive their first hepatitis B vaccine and one dose of immunoglobulins (IG) within 12 hours.
  • The baby should complete all hepatitis B vaccines as recommended during the first six months.
  • Some pregnant women may receive drugs to lower the level of HBV in their blood.

To prevent hepatitis B infection:

  • Children should get the first dose of hepatitis B vaccine at birth. They should have all 3 shots in the series by age 6 months.
  • Children who have not had the vaccine should get "catch-up" doses.
  • Children should avoid contact with blood and body fluids.
  • Children should not share toothbrushes or any other items that may be infected.
  • All women should be screened for HBV during pregnancy.
  • Mothers with an HBV infection can breastfeed their child after immunization.

References

Centers for Disease Control and Prevention. Vaccine Information Statement: Hepatitis B. CDC.gov. www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html. Accessed January 07, 2016.

Centers for Disease Control and Prevention. Vaccine Information Statement: Your Baby's First Vaccines. CDC.gov. www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html. Accessed January 07, 2016.

Jensen MK, William F, Balistreri WF. Viral hepatitis. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 358.

Jonas M, Stoll J. Hepatitis B and D viruses. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 156.

Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. AASLD guidelines for treatment of chronic hepatitis B. 2015. Hepatology. 2016 Jan;63(1):261-283. PMID: 265660644 www.ncbi.nlm.nih.gov/pubmed/26566064.

Review Date: 3/4/2016

Reviewed By: Liora C. Adler, MD, Pediatric ER, Joe DiMaggio Children’s Hospital, Hollywood, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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