hepatitis%20-%20viral%20(pediatric)
HEPATITIS - VIRAL (PEDIATRIC)
The majority of acute viral hepatitis infections are asymptomatic or they can cause an anicteric illness that may not be diagnosed as hepatitis.
Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic. Jaundice and intestinal symptoms usually resolve 2-3 weeks after onset. A patient is infectious 1-2 weeks prior to the clinical illness.
Hepatitis B, C, & D may be symptomatic depending on the mode and time of transmission.
Hepatitis A is predominantly transmitted through oral-fecal by person-person direct transmission and contaminated material or food.
Hepatitis B is transmitted perinatal, horizontal spread, percutaneous, sexual, close person-to-person contact.
Majority of hepatitis C infections are identified in children with repeated exposure to blood products.
Hepatitis D is route of transmission is through sexual, percutaneous especially IV drug use.
Hepatitis E is transmitted primarily through contaminated drinking water and oral-fecal transmission.

Patient Education

Hepatitis A & E

  • Supportive care
  • Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation

Patient/Guardian Education

  • Provide the parent &/or the patient with a detailed explanation of the patient’s condition
  • Patients must avoid food handling until they become noninfectious
  • Good sanitary practices, drinking safe water, avoiding uncooked foods & vegetables & vigorous hand-washing help diminish the risk of infection
  • A patient with Hepatitis A is infectious 1-2 weeks prior to clinical illness during the prodromal stage
    • Hepatitis A virus (HAV) infection of household contacts can be prevented by the administration of immune serum globulin

Acute Hepatitis B

  • Supportive care
  • Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation

Patient/Guardian Education

  • Provide the guardian/patient with a detailed explanation of his condition
    • Emphasize the disease’s long-term implications for their & their partners’ health
    • Provide clear, accurate, written information
  • If appropriate, advise sexually-active adolescents to avoid unprotected sexual intercourse, emphasize condom use
  • Screen for other sexually transmitted diseases (STDs) in cases of sexually-acquired hepatitis or if otherwise appropriate
  • All non-immune sexual & household contacts must be screened & vaccinated

Chronic Hepatitis B

  • 40-70% of hepatitis B virus (HBV) before 3 years of age result in chronic carrier state
    • Persistent infection develops in 90% of neonates, 20-50% of young children, & 5% of adults who acquire HBV infection
  • Course of infection in children depends mainly on age of acquisition of infection
    • Immunotolerant phase: High HBV DNA (>107 copies/mL), normal or minimally elevated alanine aminotransferase (ALT), typical in the Far East region, last for 10-30 years after perinatal infection
    • Immunoactive phase: Decrease in HBV DNA, elevated ALT
    • Seroconversion of HBeAg to anti-HBe: May take place after a sudden, asymptomatic elevation of liver transaminases; spontaneous HBV remission, rare in children
    • Chronic hepatitis B infection: Persistence of HBsAg, elevated ALT, inflammatory & necrotic changes in the liver, elevated aminotransferases level & viremia
  • Vaccination against hepatitis A for non-immune patients
  • HBV infection has been linked to the development of hepatocellular carcinoma (HCC)
    • HCC usually occurs >20 years after onset of HBV infection
    • HBV-associated HCC cases may be seen in young children before the onset of cirrhosis
  • Liver biopsy
    • Purpose is to assess the degree of liver damage, to rule out other causes of liver disease & to help predict prognosis
    • Recommended for chronic hepatitis B patients who are candidates for antiviral therapy
    • May be important when the administration of new therapy of chronic HBV becomes possible
    • The decision to perform biopsy should consider necessity & its benefits to the patient
  • Screening for HCC in children

Patient/Guardian Education

  • Provide the patient/guardian with a detailed explanation of the patient’s condition
    • Emphasize the disease’s long-term implications for their & their partners’ health
    • Provide clear, accurate, written information
  • Breastfeeding is encouraged for infants who have been properly immunized
    • Check for any open wound or bleeding in the nipple area prior to breastfeeding
  • Counseling regarding prevention of transmission of HBV
    • Sexual transmission: Protected sexual intercourse (eg condom use) 
    • Perinatal transmission: Hepatitis B immune globulin (HBIg) & hepatitis B vaccine at delivery for babies of HBV-infected mothers
    • Inadvertent transmission via environmental contamination from a blood spill

Hepatitis C

  • Supportive care
  • Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation
  • Screen for other STDs in cases of sexually-acquired hepatitis or if otherwise appropriate

Patient/Guardian Education

  • Provide the patient/guardian with a detailed explanation of the patient’s condition
    • Emphasize the disease’s long-term implications for their & their partners’ (if any) health
    • Provide clear, accurate, written information
  • Advise patient not to donate blood, semen or organs
  • Advise patient to avoid sharing items of personal hygiene (eg toothbrushes, shaving equipment)
  • Counsel patient to stop using illicit drugs
  • Advise patient regarding sexual transmission
    • HCV is not considered to be a sexually transmitted disease, but sexual promiscuity, HIV & herpes simplex virus (HSV-2) co-infections are associated with sexual transmission of hepatitis C
    • Avoid unprotected sex during menstruation
  • Advise patient regarding the potential deleterious effect of alcohol especially in association with development of HCC, progression of liver fibrosis & increase in HCV replication
  • Advise adolescent patient against smoking which could accelerate disease progression

Hepatitis D

  • Supportive care
  • Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation
  • Screen for other STDs in cases of sexually-acquired hepatitis or if otherwise appropriate
  • Consider expert referral

Partner Notification

  • Partner notification for at-risk contacts

Patient/Guardian Education

  • Provide the patient with a detailed explanation of the patient’s condition
    • Emphasize the disease’s long-term implications for their & their partners’ health
    • Provide clear, accurate, written information
  • Advise patients to avoid unprotected sexual intercourse
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