Hepatitis%20-%20viral%20(pediatric) Patient Education
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
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- 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