What is hepatitis?
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Hepatitis is the name for liver inflammation. The term is usually used for a viral infection of the liver, with hepatitis A, B, or C being the most common. Other viruses like cytomegalovirus (CMV) and Epstein-Barr virus (EBV, also known as infectious mononucleosis or mono) can cause hepatitis. Viral types of hepatitis are contagious, but the risk of spread and how they are spread vary between types. Hepatitis A, EBV, and CMV are transmitted through stool and secretions, but hepatitis B and C are spread by exposure to contaminated blood.
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Hepatitis can also be caused by noninfectious causes such as medications, chemicals, trauma, and certain metabolic diseases. These types of hepatitis are not contagious.
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Hepatitis can be acute (come and go quickly) or chronic (long term). Some children with chronic liver disease will need a liver transplant.
How common is it?
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In the pre-vaccine era, hepatitis A was one of the most commonly reported vaccine-preventable illnesses, with more than 26,000 cases per year reported to the Centers for Disease Control and Prevention. However, since the introduction of a vaccine, incidence of hepatitis A in the United States has declined dramatically, with only 5,683 cases reported in 2004. Previously rates where higher among children than adults, but since institution of the vaccine, rates among children 5 to 14 years of age have been among the lowest.
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Hepatitis B, also a vaccine-preventable infection, may be transmitted vertically from infected mothers to their babies or horizontally through contact with infected blood or sexual contact. Horizontal transmission occurs primarily in adolescents and adults. The recommendation for universal testing of mothers for hepatitis B and universal immunization of children at the time of birth has significantly lowered hepatitis B infection in children. Currently in the United States, 5% to 8% of the total population has been infected, and 0.2% to 0.9% of the population has chronic infection.
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Hepatitis C infection in the United States is estimated at 1.8% of the general population. Currently there is no vaccine against hepatitis C.
What are some characteristics of children with hepatitis?
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Children younger than 6 years usually have few or no signs or symptoms. Symptoms are more common in older children and adults.
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Jaundice, which is a yellow tint of the skin or eyes, is a common symptom.
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Other symptoms may include
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Chronic itchiness
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Dark-colored urine or clay-colored stools
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Poor appetite, nausea or vomiting, and stomach pain
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Less energy, sleeping more, and having a low-grade fever
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Who is the treatment team?
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The primary care provider in the medical home.
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Pediatric gastroenterologists may be involved.
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Pediatric infectious disease specialists may be involved.
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Parents/guardians do not have to share information about hepatitis with schools or child care providers, but it is easier to care for children when there is good communication.
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If parents share information about hepatitis, it should not be shared with staff without written permission of the parents/guardians. Confidentiality should be respected and the plan for sharing information should be very clear to all.
What adaptations may be needed?
Medications
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Do not give any over-the-counter medications such as acetaminophen (eg, Tylenol) or ibuprofen (Motrin is one brand of ibuprofen) to a child with hepatitis without permission from the health care professional.
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Note: Preventive vaccines that protect against hepatitis A and B are available and should be given according to the recommendations of the routine immunization schedule (available online atwww.cispimmunize.org,www.aapredbook.org, andwww.cdc.gov/vaccines/recs/schedules/default.htm). Immune globulin against hepatitis A may be recommended in outbreak situations.
Dietary considerations
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Because some hepatitis viruses can be spread through saliva, do not share utensils or food from the same plate with a person with viral hepatitis.
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Strict hygiene precautions are required for infectious hepatitis.
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Eating small portions more frequently or eating high-calorie foods may be necessary if weight loss is a problem. Drinking plenty of water is helpful.
Physical environment
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Adaptations will vary depending on the type of hepatitis, whether it is acute or chronic, and whether it is contagious.
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The child may need to limit activities that could lead to abdominal trauma.
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Standard precautions should be followed when blood or blood-containing fluids are handled (for all children, regardless of hepatitis status). For blood and blood-containing substances, these are the same precautions described by the Occupational Safety and Health Administration as universal precautions.
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Wear disposable gloves or, if using utility gloves, be sure the utility gloves are sanitized after use.
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Absorb as much of the spill as possible with disposable materials; put the contaminated materials in a plastic bag with a secure tie.
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Clean contaminated surfaces with detergent and water.
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Rinse with water.
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Sanitize the clean surface by wetting the entire surface with a solution of freshly diluted bleach in a 1:10 concentration. Health authorities recommend using a stronger solution of freshly diluted bleach (1:10) to disinfect surfaces that involved blood because if hepatitis B is present, the virus is know to be more resistant to being killed by bleach than many other types of infectious agents.
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Dispose of all soiled items in plastic bags with secure ties.
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What should be considered an emergency?
Call emergency medical services/911 for
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Vomiting blood
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High fever and abdominal pain or swelling
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Confusion or dramatic change of behavior
What types of training or policies are advised?
Standard precautions
What are some resources?
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Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition, American Academy of Pediatrics,www.aap.org/bookstore, 888/227-1770 -
Centers for Disease Control and Prevention,www.cdc.gov, 800/CDC-INFO (232-4636)
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.