Hepatitis in Children
What is Hepatitis A and B? How are both transmitted?
Both Hepatitis A and B are viral infections of the liver that can cause mild to severe illnesses. Both viruses can cause similar symptoms but are spread differently and can affect the liver differently.
The hepatitis B virus is spread when blood, semen, or other body fluids infected with the hepatitis B virus enter the body of a person who is not infected.
People can become infected with the virus from:
- Birth (spread from an infected mother to her baby during birth)
- Accidental cuts to the skin by sharp objects that are contaminated with an infected person’s blood or body fluids.
- Sharing needles, syringes, or drug preparation equipment
- Sharing items such as toothbrushes, razors, or medical equipment such as a glucose monitor with an infected person
- Direct contact with the blood or open sores of an infected person
- Exposure to blood from needle sticks or other sharp instruments of an infected person e.g. ear piercing, acupuncture, and tattooing.
- Sex with an infected partner
Hepatitis B virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.
Majority of Hepatitis A infection is due to consuming contaminated food, drinks, fruits, berries, and vegetables.
Swimming in contaminated water and direct contact with an infected person can also lead to Hepatitis A infection.
Besides improved sanitation and good hand hygiene, vaccination is the best protection against Hepatitis A.
The Hepatitis vaccination consists of 2 injections given 6-12 months apart in children below 12 month of age and is proven to have long lasting protection for at least 40 years in more than 90% of children.
Hepatitis A is one of the most vaccine-preventable infections in travellers.
It is given before and within two weeks after coming in contact with Hepatitis A. The Hepatitis A vaccine is recommended for those travelling to developing countries.
Always wash your hands with soap and water after using the toilet, as well as before preparing and eating food.
What are the symptoms and complications of Hepatitis A & B in children?
Both Hepatitis A and B infected persons show similar symptoms in the acute infection, though some may not show any symptoms at all. Symptoms that they can present include fever, nausea, vomiting, tiredness, loss of appetite, pale stool, dark urine and/or jaundice.
In Hepatitis A, most of the children recover in 4-6 weeks, although some may have relapsing signs and symptoms for up to 6 months. There is no carrier state.
Hepatitis B infection can begin as short-term infection, but in some cases, the virus remains in the person’s body, and causes chronic, or lifelong, infection. Over time, chronic hepatitis B (carrier) can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.
Why is it important for children to be vaccinated against Hepatitis B?
The likelihood that hepatitis B will develop from an acute infection into a chronic infection depends on the age of the person infected. The younger a person is when infected with hepatitis B virus, the greater the chance of developing a chronic infection.
Approximately 90% of infected infants will develop chronic infection. The risk goes down as a child gets older. Approximately 25%–50% of children infected between the ages of 1 and 5 years will develop chronic hepatitis B. In contrast, about 95% of adults recover completely and do not become chronically infected.
Liver cancer is one of the few cancers which risk can be greatly reduced by vaccination. Hence it is important that children get vaccinated against Hepatitis B infection as early as possible.
How is the Hepatitis B vaccine administered?
The Hepatitis B vaccination is given as an intra-muscular injection and is recommended as early as possible. If Hepatitis B vaccine (HBV) is given as a standalone vaccine, it consists of 3 doses at 0, 1 and 6 months old.
In Singapore, almost all newborns are given the first dose before they leave the hospital. The two subsequent doses may be given as a standalone vaccine or as part of the combination vaccine (DTPa/Hib/IPV/HBV, commonly known as the 6-in-1) by 6 months of age.