Hepatitis A in Children: What You Should Know
According to the World Health Organization (WHO), around 7,134 people died from hepatitis A worldwide in 2016. This represents a mortality rate of 0.5% from viral hepatitis. Hepatitis A in children is very common, so much so that in low and middle income countries up to 90% of infants become infected before the age of 10.
In most cases, the infection disappears on its own, although in some cases complications occur. Even these complications are controllable, at least when the person seeks healthcare. As Johns Hopkins Medicine points out, it’s the most transmissible type of hepatitis, but at the same time it’s the one that’s least likely to damage the liver.
Symptoms of hepatitis A in children
The incubation period of the hepatitis A virus ranges from 14 to 28 days. Not all cases develop visible symptoms during this stage, but they may do so later. Here are the most typical symptoms of hepatitis A in children:
- Nausea
- Vomiting
- Anorexia
- Fever
- General discomfort
- Diarrhea
- Loss of appetite
- Abdominal pain
- Dark urine
- Pale, clay-like stools
- Itchy skin
- Jaundice
According to some estimates , up to 82.1% of patients develop fever, so this is perhaps the most characteristic symptom. Not everyone develops jaundice, and, if they do, it happens after several weeks (and not during the incubation period). Most episodes are mild, so much so that the signs will only cause minor discomfort.
Adults usually present a much more severe course of infection; in fact complications are much more common in them. Before the age of 6, the symptoms may not appear, and this is why the infection may go unnoticed by the parents and the child.
Relapses aren’t uncommon, so one episode may be followed by another after the person has already recovered.
Causes of hepatitis A in children
Hepatitis A is caused by the hepatitis A virus (HAV). It’s a small, heat-stable, acid-resistant non-enveloped single-stranded RNA virus. The virus replicates in hepatocytes (liver cells) and interferes with liver function. This causes an immune response, resulting in inflammation of the liver.
The preferred transmission of the virus is by the fecal-oral route. This occurs when the patient drinks water or eats food with fecal particles from an infected person. It mainly happens when someone prepares food without washing their hands.
Waterborne outbreaks aren’t too uncommon, although they are almost always restricted to cases of contaminated sewage and poorly treated water.
Once ingested, the virus is absorbed from the gastrointestinal tract. Its particles are transported to the basolateral membrane of the hepatocyte through the portal circulation. After replicating in the liver, it’s excreted in the bile and released in the feces.
Patients are most contagious 2 weeks before the symptom of jaundice manifests. However, most patients are not contagious 1 week after showing this symptom.
Other routes of transmission are close contact with an infected person, mainly sexually.
Specialists consider that the people most at risk are those who travel from high-income developed countries to endemic areas of Africa, Asia, Central America, and South America. In children, most episodes occur from drinking or eating food contaminated with the virus.
Diagnosis of hepatitis A in children
As experts point out, hepatitis A in children is detected through serological tests to detect virus-specific immunoglobulin (IgM) antibodies in the blood.
Additional tests focus on detecting viral RNA, primarily using reverse transcriptase polymerase. You can also choose to look for anti-HAV immunoglobulin G (IgG).
Anti-HAV immunoglobulin G (IgG) arises soon after infection and remains in the body for life. These three indicators are used as a point of reference to diagnose hepatitis A in children.
It’s important to carry out the relevant blood tests, as the symptoms aren’t different from other types of hepatitis. Knowing with certainty the type of hepatitis is essential in order to determine the treatment and prevent the condition from developing.
Treatment options
There’s no specific treatment to deal with hepatitis A in children. As we have already explained, most cases are mild, so they disappear in a couple of weeks on their own. Specific symptoms can be treated individually according to specialist criteria, and complications related to liver damage are very rare.
It’s essential for the process to be mediated by a health specialist, as most episodes don’t require medication. In fact, in many cases, drugs can be counterproductive, as is the case with acetaminophen, paracetamol, and anti-vomiting medications. During the recovery process, the following should be taken into account:
- Avoid activities that require a lot of effort
- Drink plenty of fluids throughout the day
- Don’t expose yourself to the sun directly or wear very tight clothing (if you experience itching)
- Eat several small meals instead of large ones (to reduce nausea and vomiting)
People who live with the child should wash their hands regularly, as the interaction with them can lead to infection processes in those they have contact with. The prognosis is very good, so parents shouldn’t be alarmed after diagnosis.
Specialists also remind us that vaccination against hepatitis A is recommended for all children, which is indeed an effective preventive method to reduce the chances of complications developing even more.
- Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A: Epidemiology and prevention in developing countries. World J Hepatol. 2012;4(3):68-73.
- Iorio, N., & John, S. Hepatitis A. In StatPearls [Internet]. StatPearls Publishing. 2021.
- Koenig KL, Shastry S, Burns MJ. Hepatitis A Virus: Essential Knowledge and a Novel Identify-Isolate-Inform Tool for Frontline Healthcare Providers. West J Emerg Med. 2017;18(6):1000-1007.
- Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S. Hepatitis A in children- clinical course, complications and laboratory profile. Indian J Pediatr. 2014 Jan;81(1):15-9.
