Hepatitis B in Children

Philip Rosenthal, MD
Professor of Pediatrics and Surgery
Medical Director, Pediatric Liver Transplant Program
Director, Pediatric Hepatology
University of California, San Francisco

Based upon CDC statistics, an estimated 80,000 persons in the USA were
infected with the hepatitis B virus (HBV) in 1999. People of all ages,
including children, can get hepatitis B and about 5,000 die per year from
sickness caused by HBV. You can get hepatitis B by direct contact with the
blood or body fluids of an infected person. This can occur by having sex or
sharing needles with an infected person. A baby can get hepatitis B from an
infected mother at childbirth. It is estimated that one out of 20 people in
the United States will get infected with HBV some time during their lives.
The risk is higher if your parents were born in Southeast Asia, Africa, the
Amazon basin in South America, the Pacific Islands, and the Middle East.
Hepatitis B is NOT spread through food or water or by casual contact.
Persons at risk for HBV may also be at risk for Hepatitis C Virus or HIV.

 

Pregnant women can transmit hepatitis B to their baby. Babies who get HBV at
birth may have the virus for the rest of their lives, can spread the
disease, and can develop cirrhosis of the liver and even liver cancer. All
pregnant women should be tested for HBV early in their pregnancy. Many
states have laws mandating this testing. If the blood test is positive, the
baby should receive the hepatitis B vaccine along with another medication,
hepatitis B immune globulin (HBIG), at birth or very soon thereafter. The
second dose of the vaccine should be given at 1-2 months of age and a third
dose at 6 months of age. This important regimen may prevent transmission of
HBV to the newborn.

The term "hepatitis B carrier" refers to people who are infected with HBV
and never recover fully from the infection. These people carry the virus and
can infect other individuals for the rest of their lives. In the United
States about 1 million people carry HBV.  Many people may carry HBV and not
know it. Many people carry the HBV infection and have no symptoms at all.
This is particularly true in children. Symptoms of HBV infection may include
your eyes or skin turning yellow, a loss of appetite, nausea, vomiting,
fever, stomach or joint pain, and fatigue. Only a blood test can determine
for sure if a person is infected with HBV.

The best protection against HBV infection is the hepatitis B vaccine.
Scientific data shows the hepatitis B vaccine is safe and effective for
infants, children and adults. Current data show that vaccine induced
hepatitis B antibody levels decline with time. However, there is no need to
obtain a booster dose of vaccine since immune memory (anamnestic anti-HBs
response) will protect immunized individuals if exposed to HBV.

All children from 0-18 years of age should routinely receive the hepatitis B
vaccine in the United States. Many states have laws mandating hepatitis B
vaccination for school entry. The number of new infections per year of
hepatitis B has declined from an average of 260,000 in the 1980s to about
78,000 in 2001. The greatest decline has happened among children and
adolescents due to routine hepatitis B vaccination. The latest estimates
suggest 1.25 million chronically infected Americans with HBV, of whom 20-30%
acquired their infection during childhood.

The treatment and medical management of HBV infection in children should be
coordinated by individuals with expertise in the field. HBV infected
children should be evaluated by their doctor for liver disease. Alpha
interferon and lamivudine are two drugs licensed by the FDA for the
treatment of children with chronic hepatitis B. Preliminary data suggests
that children who have been infected for shorter periods of time, may
respond better to these drugs than adults. Another drug, adefovir dipivoxil,
has recently been approved for use in adults. Adevofir is not approved for
use currently in children, but studies in children with chronic HBV
infection are planned.

In summary, HBV infection occurs in newborns, infants and children and is
frequently unrecognized. Compared to the disease in adults, hepatitis B in
children is frequently less severe but more likely to be prolonged. Children
might have a better response to therapy, but this is based on preliminary
data. Education is important to prevent transmission of hepatitis B
infection to children. Vaccination holds the key to eradication of hepatitis
B.



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