Causes
Hepatitis is an inflammation of the liver caused by infection with various viruses. These include hepatitis A (infectious hepatitis), hepatitis B (serum hepatitis) and hepatitis C. There’s also a disease called auto-immune hepatitis, where a person’s immune system attacks the liver, which isn’t discussed here.
Hepatitis A
Hepatitis A (infectious hepatitis) is transmitted through objects, food or water that have come into contact with an infected person’s poo. The incubation time for the disease is 4-6 weeks. The illness tends to be worse in adults.
Hepatitis B
Since the hepatitis B vaccine was introduced to the free immunisation program for Australian children, rates of hepatitis B in children have fallen significantly.
Hepatitis B can be passed from an infected mother to her child. This is most likely to happen shortly after birth, although it might happen in the uterus or during birth. When a baby is born to a mother with hepatitis B, it’s important for the baby to receive doses of both hepatitis B vaccine and hepatitis B immunoglobulin during the first day of life. This treatment can reduce the risk of the baby being infected.
Unless they receive immunisation immediately at birth, 70-90% of babies who are infected at birth from their mother will develop chronic hepatitis B (also known as a ‘carrier’ state). This means they have the virus and might pass it on to others, but they don’t always show the symptoms. In contrast, only 5% of adults develop a chronic hepatitis B infection.
A chronic infection is very serious, because it’s associated with a very high risk of developing liver cancer or chronic liver disease.
Children can get hepatitis B from needlestick injuries, but contaminated needlestick injuries are extremely rare.
In adults, the risk of hepatitis B is greatest among drug users who share needles, although it can also be transmitted during sexual activity.
Hepatitis C
Hepatitis C is rare in children. Adults who get it are mostly drug users who pick up the virus from contaminated needles. Because hepatitis C is transmitted in blood, it can be caught from toothbrushes or razors used by an infected person. A mother with hepatitis C can pass this illness onto her baby during pregnancy, although the chance of this happening is only 1-5%.
More than 85% of children infected with hepatitis C will develop chronic hepatitis C (become carriers of the disease), although they mostly won’t show the symptoms of the virus. Chronic hepatitis C is associated with complications, including chronic liver cirrhosis in adulthood. There are some new treatments that can cure chronic hepatitis in some people.
Symptoms
The symptoms of viral hepatitis A and B can be very similar, although hepatitis A tends to be more sudden in onset than hepatitis B.
A child with hepatitis A usually gets tired easily and has fever, nausea, loss of appetite, vomiting and diarrhoea. The child’s skin might feel very itchy, and her tummy might be a little swollen and sore, especially over the upper right side, where the liver is. After several days, her wee might turn dark yellow or brown, and her skin might go a yellowish colour (jaundice). Getting better might take several weeks.
Children under 12 months don’t usually show any symptoms of hepatitis. If an older child is infected with hepatitis B, he might first complain of aching joints and might have a skin rash.
Hepatitis B tends to be worse than hepatitis A. It also tends to take longer to show up because of its long incubation period (between 45-160 days).
When to see your doctor
If your child has any of the above symptoms, or if you think you or your child might have come into contact with the virus, see your doctor.
Tests
The diagnosis of hepatitis can be confirmed with blood tests.
Treatment
If your child’s symptoms are severe, she might need to go into hospital. A child with hepatitis A usually improves after two weeks, but hepatitis B can be a prolonged illness.
There’s no cure for hepatitis A or hepatitis B, so treatment aims at improving symptoms. Treatment includes rest, as well as a special diet free of fatty foods.
If a baby or child develops chronic hepatitis B, the current recommendation is that some anti-viral medications might be considered years later, after liver damage has occurred. This area is constantly being researched and revised.
New treatment with pegylated interferon and ribavarin (anti-viral drugs) is available for hepatitis C sufferers. These treatments can lead to a cure for many of those patients, including children.
Prevention
Good hygiene and proper sewerage are critical in the prevention of hepatitis A. If you’re travelling with your child to places where there might be a high risk of exposure to hepatitis A (for example, isolated communities in tropical Australia or any developing countries overseas), hepatitis A immunisation is recommended. You should get immunised more than one month before you travel.
Hepatitis B vaccination is included in the free government immunisation program for all children. Hepatitis B immunisation needs three doses over 4-6 months. It’s very safe and highly effective at preventing infection. Most children handle this vaccine well.
There’s no vaccine against hepatitis C.
