Viral Hepatitis

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KEY POINTS

• Viral hepatitis is an infection of the liver by a virus. The liver is one of the largest organs and helps keep your child’s body healthy.
• Your child should rest while he or she has fever or jaundice. Some medicines are used to treat chronic (long-term) hepatitis and may help reduce the virus to almost undetectable amounts. Some types of hepatitis can be cured.
• Hepatitis A and hepatitis B can be prevented with vaccines that all babies should receive. If your child did not get the hepatitis vaccines as a baby, he or she may get the shots later in childhood or as a teenager.

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What is viral hepatitis?

Viral hepatitis is an infection of the liver by a virus. The liver is one of the largest organs and helps keep your child’s body healthy. Some of the functions of the liver include:

• It helps the body get rid of some medicines and harmful substances.
• It makes bile, which helps the body digest fats.
• It stores glucose (sugar), which the body uses for energy.
• It makes many proteins, which are the building blocks for all cells in the body.

When your child has hepatitis, the liver is irritated (inflamed). It may be swollen and tender.

What is the cause?

Different types of hepatitis are caused by different viruses.

Hepatitis A is caused by the hepatitis A virus. This is the most common cause of hepatitis in children. The virus is spread by contact with infected bowel movements. Someone who is infected may pass the infection to others by not washing his or her hands, especially after using the bathroom. It is also possible to pass the virus by not washing your hands after changing a diaper or helping a child use the toilet. Sometimes there are outbreaks of hepatitis A at day care centers or restaurants. Your child might also get the virus from:

• Eating food handled by an infected person
• Drinking untreated water or eating food that was grown, washed, or prepared in untreated water

Hepatitis B virus is the second most common type of hepatitis in children. It can spread from contact with the blood or other body fluids of someone who is infected with the virus. For example, your child can get it from:

• Needles that have blood on them from an infected person that may have used for piercing, tattoos, or injecting drugs
• Sexual contact
• Exposure to the blood, semen, or vaginal fluid of someone who is infected
• Bites from an infected person
• Touching open cuts or sores of an infected person
• Sharing toothbrushes or other personal items used by an infected person
• Food that was chewed (for a baby) by an infected person

Teach an older teen to practice safe sex. Teach your teenager to use latex or polyurethane condoms the right way during foreplay and every time he or she has vaginal, oral, or anal sex. Teach your teen to have just 1 sexual partner who is not sexually active with anyone else and who will use protection every time your teen has sex.

The virus can live on objects for 7 days or more. Even if you don’t see any blood, there could be virus on an object.

A pregnant woman can pass hepatitis B to her baby if she is infected when the child is born.

Having long-term hepatitis B can increase your child’s risk for having hepatitis D also.

Hepatitis C is spread mainly through contact with the blood of someone who is infected. This can happen from needle sticks with infected needles or anything else that has blood on it. Sometimes it is spread through sexual contact. A pregnant woman can pass hepatitis C to her baby if she is infected when the child is born, though the risk is low. There is little risk for spread through breastfeeding.

There are also other types of hepatitis that are not as common.

Your child has a higher risk for infection if he or she has not had a hepatitis A or hepatitis B vaccine and:

• Lives, travels, or goes to school in an area that has outbreaks of hepatitis A
• Uses illegal drugs
• Has HIV/AIDS
• Is sexually active with multiple partners and does not always use condoms

Hepatitis is not spread by hugging or kissing, sneezing, coughing, or casual contact.

What are the symptoms?

Young children may have no symptoms. For older children, symptoms may include:

• Yellowish skin and eyes (jaundice)
• Feeling tired all the time
• Dark urine
• Pain just below the ribs on the right side, especially if you press there
• Loss of appetite
• Nausea and vomiting
• Bowel movements that are whitish or light yellow and may be looser than normal
• Joint pain
• Fever

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s medical history and symptoms and examine your child. Your child will have blood tests. If blood tests show that the liver is not working normally, your child will have tests to find out if a virus is causing the problems. The tests will also determine the type of virus causing the infection.

What is the treatment?

The main treatment is rest. Your child should rest while he or she has fever or jaundice. When fever and jaundice are gone, your child may start increasing activity according to your child’s healthcare provider’s advice.

Once your child recovers from hepatitis A, the virus leaves the body.

Hepatitis B or C viruses, however, sometimes stay in the body and cause a long-term infection. This means the virus keeps affecting the liver for several months or years. Damage to the liver by the infection can lead to other health problems such as scarring (cirrhosis) of the liver or even liver cancer. Antiviral medicines may be used to treat long-term hepatitis B or C, and they control or cure the infection. Your child’s provider will test your child’s blood at follow-up appointments for signs of long-term liver disease.

How can I help take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Your child should avoid taking medicines that can damage the liver such as acetaminophen. Ask your child’s provider which medicines are safe for your child.
• Your child will need to get plenty of rest while healing. As the symptoms get better, your child may start being more active. It’s best to avoid a lot of physical exertion until your child's healthcare provider says it's OK.
• Give your child small, high-protein, high-calorie meals, even when he or she feels nauseated. Sipping soft drinks or juices and sucking on hard candy may help your child feel less nauseated. Your child should not drink any alcohol.

Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent hepatitis?

Hepatitis A and hepatitis B can be prevented with vaccines that all babies should receive. If your child did not get the hepatitis vaccines as a baby, your child may get the shots later in childhood or as a teenager.

The best way to prevent exposure to infected body fluids is good hand washing. Children should wash their hands every time they go to the bathroom, at home, at day care, and at school or work.

If someone in your household has hepatitis:

• Ask your healthcare provider if others in the family need to get a hepatitis shot.
• Wear disposable gloves if you must have contact with the sick person's bowel movements, body fluids, clothing, towels, or bed linens. Wash your hands with warm running water and soap after removing the gloves.
• Wash the infected person's clothing and bed linens separately from other laundry. Use very hot water and a strong detergent.
• Clean toilets and other bathroom surfaces with a disinfectant. Wear gloves when you clean. If possible, it's safest to have the infected person use a different bathroom than everyone else in the household for about 1 month after they first get sick.
• Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs. For an older child, advise your child to avoid sexual contact with others until your child’s provider says it’s OK. Teach your teenager to use latex or polyurethane condoms the right way during foreplay and every time he or she has vaginal, oral, or anal sex, and to have just 1 sexual partner who is not sexually active with anyone else and who will use protection every time your teen has sex.