Common Childhood Conditions: What You Need To Know About Hepatitis A and B

When your child is born, there is a list of recommended jabs for the little one. Among them are vaccinations for hepatitis. Prof Quak Seng Hock, head and senior consultant, Division of Paediatric Gastroenterology, Hepatology and Nutrition, National University Hospital, discusses why it is important to protect your child against hepatitis.

What causes hepatitis?

Hepatitis is an inflammation of the liver. Most commonly, it is due to an infection of the liver. The affected patient may be completely asymptomatic or feel unwell and tired. There may be mild right upper abdomen pain. Jaundice can be present.

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The two common viruses that infect the liver are hepatitis A and hepatitis B. Hepatitis A is transmitted via the faecal-oral route via contaminated water supply. It is more common in countries where water supply is not safe, for example, in places where the public obtain their water from a well or river. The other source of infection is from contaminated shell fish.

Hepatitis B is usually transmitted from person to person through close body contact where the virus can be transmitted through bodily fluid. In places where blood donation is not properly screened, hepatitis B can be transmitted through blood transfusion. Among drug addicts, the sharing of intravenous needles transmits hepatitis B. If a mother is a hepatitis B carrier, she can pass the virus to her newborn baby during childbirth.

What are the symptoms?

The incubation period of hepatitis A is shorter than hepatitis B — usually within a couple of weeks.  Patients with acute hepatitis will have lethargy, fever, poor appetite, vomiting and jaundice. This period may last for one to two weeks before recovery. In more severe cases, hepatitis A will develop into acute liver failure and the patient can get very sick. However, the vast majority of hepatitis A patients have a very mild disease and patients may not be aware that they have hepatitis.

Acute hepatitis B presentation is quite similar to that of hepatitis A. Hepatitis B patients can be asymptomatic carriers. This is particularly true in babies who are infected by their mothers during childbirth. The virus remains in the liver and, after a long period, the liver is damaged and the hepatitis B-carrier patients may end up having chronic hepatitis, liver cirrhosis and even liver cancer.

How is hepatitis treated?

As the majority of the patients infected by hepatitis A or B are asymptomatic or have very mild symptoms, no treatment is necessary. In patients with acute hepatitis, bed rest is an important part in the management of the disease. During the acute stage, affected patients usually feel very tired and nauseated, and should avoid oily meals. The biochemistry of the liver function needs to be monitored and in more than 95 per cent of cases, spontaneous recovery is expected within a couple of weeks. In a small minority of acute hepatitis cases, the liver function continues to deteriorate and ends in liver failure. In these cases, a liver transplant is the treatment option.

Long-term sequelae of acute hepatitis A is uncommon. However, in acute hepatitis B, some patients may develop chronic hepatitis B, leading to liver cirrhosis. In children, most cases of chronic hepatitis B are asymptomatic and do not require treatment. For those with persistent abnormal liver function, antiviral treatment may be necessary.

How can I prevent it?
It is good practice to ensure personal hygiene and hand washing before any food or drink.  Avoid drinking water from unsafe sources (if unsure, boil all drinking water). This can prevent a number of infections transmitted by the faecal-oral route, including hepatitis A.

Get vaccinated
Vaccination against hepatitis A is available and two doses of the vaccine are necessary to achieve good protection. Vaccinations for hepatitis B are routinely given to all infants in early infancy and this provides more than 95 per cent protection against hepatitis B after completion of the vaccination schedule.

Hepatitis A and hepatitis B vaccines have been on the market for many years. Other than local injection-site pain and swelling, there are few side effects. In some patients, fever and lethargy may develop after vaccination. This is usually mild, lasting a short period of time.

The protective period of hepatitis B vaccine is very long, lasting many years. At this moment, there is no international recommendation for a booster dose in childhood as a vast majority still have immunity and memory.

Professor Quak Seng Hock is the head and senior consultant, Division of Paediatric Gastroenterology, Hepatology and Nutrition, National University Hospital. He has been a paediatrician since 1979 and was the founder President of the College of Paediatrics and Child Health, Singapore. His special interests are in children with abdominal pain, diarrheal diseases and childhood cholestasis.

To learn more about other common childhood conditions, click here

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