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