Viral Hepatitis

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Viral hepatitis is caused by hepatotropic viruses, which mainly include hepatitis A, B, C, or E virus (HAV, HBV, HCV, or HEV). Although this liver condition is usually mild in children, it may cause severe inflammation, fibrosis, or cirrhosis of the liver. Liver failure or hepatocellular carcinoma (HCC) occurs in rare cases.
  • Hepatitis A and B are vaccine-preventable. The incidence of hepatitis A and B infection in the United States has significantly decreased with implemented universal vaccination in children.
  • Hepatitis A or E infection is acute and rare in developed countries. Hepatitis B or C is usually chronic via mother-to-child vertical transmission in children.
  • Cure of hepatitis C can be achieved with potent antiviral therapy.

EPIDEMIOLOGY

Incidence

  • Hepatitis A: Close to 5,000 cases in 2021 were reported to Centers for Disease Control and Prevention (CDC) in the United States with rare cases in children.
  • Hepatitis B: Acute infection is extremely rare, and chronic infection is primarily transmitted vertically in children in the United States.
  • Hepatitis C: The incidence has significantly increased in recent years in the United States with the peak age of 20 to 39 years. This may increase the risk for hepatitis C infection in children born to infected mothers.

Prevalence

  • Hepatitis B: It is estimated that >2 million people in total with chronic hepatitis B infection are living in the United States; the higher prevalence is seen in certain subgroups such as foreign-born persons or immigrants from endemic areas.
  • Hepatitis C: An estimated total of 2.4 million people are living with hepatitis C in the United States (85% chronically infected).
  • Chronic hepatitis B or C infection in children are less prevalent in recent years. The goal is to eradicate HBV and HCV in children.

RISK FACTORS

  • Hepatitis A and E (transmission: fecal–oral)
    • Day care attendance, household exposure, travel to endemic areas
    • Maximum infectivity 2 weeks before jaundice
  • Hepatitis B and C (transmission: blood, body fluids, and sexual contact)
    • Infants born to a mother with hepatitis B or C
    • Household contacts with hepatitis B or C
    • IV drug users
    • Multiple sexual partners
    • Men who have sex with men
    • Body piercing and tattoos
    • HIV-positive status

GENERAL PREVENTION

  • Good sanitation, hygiene, vaccination, screening blood products, condom use, safe disposal of needles; avoid sharing of toothbrushes, nail clippers, and razors.
  • Hepatitis A
    • Vaccination of all children between the ages of 1 and 18 years
    • Infants who travel to an endemic region: Prior to travel, hepatitis A vaccine should be administered to infants aged 6 to 11 months, and the 2-dose series should be repeated according to the routine hepatitis A vaccine schedule. Infants aged <6 months should receive immune globulin (Ig) before travel.
    • Postexposure prophylaxis consisting of hepatitis A vaccine and/or Ig: Hepatitis A vaccine should be administered as soon as possible <2 weeks of exposure for healthy children >1 year of age who are unvaccinated. In addition to hepatitis A vaccine, Ig should be considered for immunocompromised patients or patients with chronic liver disease. Ig should be administered for infants as soon as possible after exposure. Measles-mumps-rubella and varicella vaccines should not be administered <6 months after receiving Ig.
    • Infected children should not return to school or day care center until 1 week after onset of the illness.
  • Hepatitis B
    • Increase screening for hepatitis B virus surface antigen (HBsAg).
    • Universal screening of pregnant women for HBsAg; women with positive HBsAg, high viral loads, or previous vertical transmission should consult a high-risk obstetrician and a hepatologist during early pregnancy. If HBsAg is positive and HBV DNA is >200,000 IU/mL, maternal antiviral therapy started at 28 to 32 weeks of gestation is recommended.
    • Hepatitis B vaccine to all infants at birth; complete 3-vaccine series during infancy.
    • Vaccine and hepatitis B immunoglobulin for high-risk infants at birth
  • Hepatitis C
    • Increase screening for HCV antibody.
    • Elective C-section has not been shown to reduce vertical transmission.
    • During vaginal delivery, avoid fetal scalp monitoring and prolonged rupture of membranes >8 hours.
    • Breastfeeding is contraindicated only if mother has active bleeding from nipples.

PATHOPHYSIOLOGY

  • Acute viral hepatitis tends to affect the liver parenchyma, whereas chronic viral hepatitis affects portal and periportal areas.
  • Chronic viral hepatitis B or C infection is defined by continuing viral replication and inflammation of the liver for >6 months.
  • Ongoing worsening of liver injury can lead to extensive fibrosis, cirrhosis, and HCC.

There's more to see -- the rest of this topic is available only to subscribers.