Hepatitis B in Infants and Children

Find out all about Hepatitis B in children and the treatment options.

According to the World Health Organization (WHO) an average of 240 million people worldwide suffer from chronic hepatitis B. Serious infections can lead to liver cirrhosis, cancer, and even premature death. Today we’ll review everything you need to know about hepatitis B in infants and children, with an emphasis on treatment options.

Not all cases of pediatric hepatitis B are serious. In fact, most episodes are mild or moderate and go away without needing treatment in a month or two. Despite this, complications are the order of the day, so parents should be aware of the characteristics of the infection. This is particularly the case in relation to the vaccine.

Symptoms of hepatitis B in babies and children

The clinical manifestation of hepatitis B in infants and children depends on the person’s immune status, the level of virus replication, and the age of infection. Many of the patients don’t develop symptoms, or, if they do, they are very mild. The symptoms manifest between 25 to 180 days after exposure to the virus and are characterized by the following:

• A loss of appetite
• Nausea
• Vomiting
• Joint pain
• Slight fever
• Widespread rashes (with and without itching)
• Yellow skin and eyes
• Fatigue or tiredness
• Pain in the upper right part of the abdomen

Researchers categorize three types of hepatitis B in infants and children: self-limited acute hepatitis, chronic hepatitis, and massive hepatic necrosis leading to acute liver failure.

It’s estimated that up to 90% of the children who acquire hepatitis B virus infection are at risk of developing chronic episodes. On the contrary, adults usually manifest only self-limited acute episodes.

Severe episodes are characterized by chronic liver disease and hepatocellular carcinoma, primarily. This is why it’s so urgent to counteract the evolution of the infection.

Finally, massive hepatic necrosis is very rare; So much so that less than 1% of the cases trigger this. The symptoms described should be taken as a warning sign of a possible infection.

Causes of hepatitis B in infants and children

Hepatitis B is caused by the hepatitis B virus (HBV). Unlike the hepatitis A virus, it isn’t transmitted through contaminated food or water.

It spreads through contact with bodily fluids from an infected person –  blood, semen, vaginal fluids, and saliva. In the specific case of hepatitis B in infants and children, the episodes are triggered by the following:

• During birth when the mother has the infection.
• Living in the same house with a person with the virus (especially when sharing toys, eating utensils, and so on).
• Receiving multiple blood transfusions due to health complications.
• Being bitten by someone infected with the virus (when there’s a break in the skin).
• Being a hemodialysis patient.

Although it’s true that the virus affects other areas of the body, its greatest impact is felt in the liver. It especially affects liver cells known as hepatocytes.

The virus begins to reproduce within these cells, which leads to their destruction or death. When only a few of these die, no major problems occur, the problem is when thousands and thousands die.

Luckily, most of the episodes develop slowly. The virus lodges in the cells, but it reproduces progressively. It’s for this reason that many children or babies don’t show symptoms, and these don’t appear until weeks or months after the infection.

Vertical transmission is the main cause of hepatitis B in infants and children. That is, the infection that occurs before birth, during birth, or postpartum.

It is thought that up to 95% of infants infected before delivery develop severe symptoms, in such a way that they’re unable to eliminate the virus during the first six months of life.

Diagnosis of hepatitis B in infants and children

As experts point out, people at high risk should undergo medical tests to determine whether the virus is present. In this case, we’re talking about the presence of the infection in the mother and other members of the family.

The diagnosis of hepatitis B is made through blood tests to detect HBsAg, hepatitis B surface antibodies (HBsAb), and hepatitis B core antibodies (HBcAb).

The mere presence of HBsAg is an indicator of the infectious process. For its part, the presence of HBsAb indicates a process of immunity or recovery from the virus (underway or already successful).

Finally, HBcAb manifests itself at the beginning of an acute process. However, together with other factors, it can also indicate a serious condition. Sometimes the DNA of the virus may be the only marker present in early infections.

Blood tests are the only method that can detect the infection promptly. The symptoms are taken as a reference, of course, because by themselves, they aren’t enough to offer a certain diagnosis. Early detection is vital in order to prevent a chronic evolution, especially in babies or children born to mothers infected with the virus.

Treatment options

In general, mild cases aren’t usually treated. If the evaluation determines that the liver isn’t in danger, or is in the process of recovery, doctors may or may not choose to address the symptoms. Conversely, severe cases require immediate intervention.

So far, interferon alfa-2b (Intron A) injections are the only approved antiviral treatment to treat hepatitis B. The second option available is the oral medication lamivudine (Epivir-HBV). Through these, the evolution of the infection can be controlled, and is done effectively in almost all cases.

During this process, supplements or interactions with agents that can harm the liver should be avoided. Consult with the specialist about what things to avoid in this sense.

Although it isn’t considered a proper treatment, timely vaccination can prevent up to 95% of serious cases of hepatitis B in infants and children. Pregnant women should be tested for the infection so that action can be taken in the first hours after birth.