hepatitis B in children

Hepatitis B in children and adults poses a serious threat to humanity: the annual increase in the incidence of this viral hepatopathology is 14-15%.

Every year, more than 50 million new cases of infection are recorded, of which about 2 million people die from complications, more than 400 million people on earth are carriers of the virus, sometimes without even knowing it. Hepatitis B is especially dangerous for children under 2-3 years old. Most often, HBV (Hepatitus B Virus) affects infants under one year old, this is due to epidemiological factors and vertical transmission of the virus.

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Epidemiology of hepatitis B in children

Previously, it was believed that the main route of transmission of the hepatitis B virus was parenteral, the disease was even called serum hepatitis. At present, it has been proven that hepatitis is transmitted through blood only in 45-50% of all diagnosed cases, mainly in adults. Children are most often infected by the so-called vertical route.

Routes of infection with hepatitis B in children under one year:

1. Intranatal – in 90% of all diagnosed cases. Infection develops as a result of the child swallowing the secretions of the infected mother during passage through the birth canal, due to damage to the mucous membranes, their contact with infected maternal blood.
2. Transplacental – 6-8% of all recorded diseases. Infection is possible against the background of placental abruption, its dysfunction (FPN – fetoplacental insufficiency).
3. Postnatal – 1-2%. This route of transmission of the virus is possible provided that there are such factors as a violation of the integrity of the mucous membranes in the child, close contact with the infected mother (care, breastfeeding).

The epidemiology of hepatitis B in children also suggests a parenteral (artificial) route, that is, the penetration of the virus into the blood during medical procedures (injections, blood transfusions), but such facts are extremely rare, according to statistics, they are the cause of infection of no more than 0.5% of children from the total number of diagnosed hepatitis.

The severity of infection directly depends on the trimester of pregnancy during which transplacental infection occurred, on the composition of the mother's blood (her immune activity). If the virus penetrates the fetus before the third trimester, the risk of infection of the infant does not exceed 10%, if later, the probability of infection with hepatitis B increases to 70-80%. Intrauterine infection with the virus threatens premature birth, but if the pregnancy is maintained and hepatitis in the infant is diagnosed as acute, the disease in most cases is mild. However, 95% of children remain carriers of the HBsAg antigen for life, creating a risk of subsequent transmission of the virus to other people, as well as provoking conditions for the development of liver cirrhosis and even carcinoma. Such a high degree of susceptibility to the virus is explained by immaturity, underdevelopment of immunity in infants.

The greatest danger is posed by infection with the HBsAg antigen, the outer shell of the main hepatitis B virus, previously called the Australian antigen. This hepatitis B marker can be detected in virtually all liquid biological environments of an infected person - in lacrimal secretion, urine, saliva, gastric juice, breast milk, feces, pleural or synovial environments. The epidemiology of hepatitis B in children is specific in that the virus quickly spreads through all liquid environments in the child's body and affects the liver parenchyma. The acute form progresses quickly and most often ends in recovery with the preservation of persistent immunity to the virus throughout life. There are frequent cases of asymptomatic progression of the disease, when hepatitis develops sluggishly, latently, which can lead to gradual scarring of liver tissue in adulthood against the background of an absolutely healthy lifestyle. It is also important to remember that after the acute form of hepatitis, a sick child can pose a threat in terms of infecting others for about 3 months; in the chronic form, children are considered lifelong carriers of the virus.

Epidemiology of hepatitis B in children

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Cause of Hepatitis B in Children

The main source of infection, i.e. the cause of hepatitis B in children, is direct contact with a sick person, most often with an infected mother. As is known, most cases of virus penetration into the child's body are associated with vertical transmission, most often in utero and during childbirth. It happens that a pregnant woman is a hidden carrier of hepatitis B and does not undergo a proper gynecological examination when registering, also hepatitis diagnosed and not immunized in time during pregnancy can become a serious threat in terms of infection of the fetus. All other reasons can be conditionally divided into the following:

• Parenteral, instrumental - injections, blood transfusions, dental procedures.
• Parenteral, hematogenous (contact with infected blood) – direct penetration of infected blood into the bloodstream of a healthy child through transfusion (hemotransfusion).
• Household route, which is a rare cause, since hepatitis B is not transmitted by airborne droplets. But if the baby's mucous membranes or skin are damaged, there is close contact with a sick person or household items that he uses, then the possibility of infection remains.

Breast milk, contrary to popular belief, is not the cause of hepatitis B in children. A nursing mother infected with HBV does not pose a threat to her baby, since the virus cannot be transmitted through milk, however, when feeding, it is necessary to monitor the condition of the nipples: there should be no wounds or cracks on them, through which hepatitis can penetrate into the mucous membranes of the child's mouth.

If a child lives in a family where there are chronic carriers of the hepatitis B virus, the risk of infection increases significantly, therefore, in addition to the fact that each family member should have individual personal belongings, cutlery and observe general safety rules, it is advisable for the whole family to undergo the vaccination procedure.

What causes hepatitis B?

Symptoms of Hepatitis B in Children

Symptoms of hepatitis B in children depend on the stage of the disease, which may be as follows:

Incubation. This is the time from the fact of infection to the first clinically manifested symptoms. Incubation can last from 30 days to six months. If hepatitis has entered the child's body through everyday life, which is rare, then the incubation phase lasts for months. In cases where infection occurs through injection or intrapartum, incubation takes no more than a month. During this time, hepatitis B does not manifest itself with any of the characteristic signs, it can be detected by random laboratory blood tests, or if there is a suspicion of a possible disease due to infection of the mother.

The pre-icteric stage of hepatitis B begins with the very first signs of the disease and develops until the specific coloration of the skin and sclera of the eyes appears. Among the weakly manifested clinical symptoms, the following can be distinguished:

• Subfebrile body temperature.
• Lethargy, decreased activity.
• Loss of appetite.
• Rarely – nausea and vomiting, which are characteristic of the acute form of hepatitis.
• Change in urine color, it becomes darker than usual.
• Change in the color of feces, it becomes lighter.
• Transient abdominal pain may occur.
• Colic, increased flatulence.
• At this stage, the liver becomes denser and, when palpated, feels like an enlarged, hard organ.

The icteric period of hepatitis B is one of the most obvious manifestations of the viral disease in the clinical sense. The skin, sclera of the eyes, and even the mucous membrane of the mouth are colored yellow. The baby's health worsens, intoxication develops, the body temperature rises to 38 degrees, and typical right-sided abdominal pain appears. Children are capricious, refuse to eat, and noticeably lose weight. A specific symptom is considered to be a bad breath, similar to the smell of spoiled apples. The icteric stage lasts about a week, and can sometimes stretch to two weeks. The acute form of the disease is accompanied by subcutaneous small hemorrhages, which are not specific as symptoms of hepatitis B in children. Among the cardiological manifestations, a decrease in the level of heart contractions is noticeable, and blood pressure drops. Neurological symptoms are manifested in sleep disturbances, lethargy, and apathy. In severe forms of hepatitis, a comatose state is possible.

The recovery stage begins from the moment the skin returns to its normal color, that is, from the day when jaundice begins to disappear. The recovery period can be quite long and last up to several months. During this time, children's appetite returns, they sleep better, are more active and mobile. The temperature can remain within the range of 37-37.5 degrees, but does not prevent the child from feeling normal.

It should be noted that the symptoms of hepatitis B in children also depend on the form in which the disease occurs. Acute hepatitis is the most common phenomenon, the entire period of the disease rarely lasts more than one month and the symptoms are very typical and clinically manifested. As a rule, children recover quickly after acute hepatitis B. Chronic disease often occurs in an asymptomatic form, it is especially difficult to notice the incubation and pre-icteric period.

Symptoms of Hepatitis B in Children

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Diagnosis of hepatitis B in children

Diagnostic measures for hepatitis B are extremely difficult, since most often the disease is asymptomatic, in a latent form. Only when the icteric stage develops, hepatitis manifests itself clinically, but there are also anicteric variants that are recognized only by the destruction of liver tissue. Mild symptoms, the absence of a clear clinical picture, especially in newborn babies, lead to the fact that it is necessary to diagnose an already affected liver in a hospital setting. At this stage, the doctor has enough anamnestic information, as well as general blood and urine tests and an ultrasound examination of the abdominal organs. Biochemical studies of blood serum are needed more to determine the degree of liver damage than to confirm the disease. Diagnosis of hepatitis B in children is important as a preventive measure or to recognize hidden carriage. In this case, the surface antigen (HBsAg) and antibodies to it are detected.

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Treatment of hepatitis B in children

The main goal of therapy is to minimize viral exposure, stress on the liver and other internal organs and systems of the body. The basic drugs for treatment are the interferon group.

The tasks that are solved by the treatment of hepatitis B in children are divided into 4 stages:

1. Suppression and stopping of viral activity in the acute form of the disease.
2. Normalization of transaminase, bilirubin and prothrombin levels.
3. Suppression of viral activity in chronic disease.
4. prevention of possible progression of pathological consequences and development of liver cirrhosis or carcinoma.

Basic treatment for hepatitis B in children does not differ in its basic principles from the treatment of hepatitis A and consists of the following:

• Strict diet, table No. 5 according to Pevzner.
• Limitation of physical activity.
• Interferon therapy.
• Hepatoprotectors of plant origin (Hepatofalk, Hofitol).
• Vitamin therapy - vitamins A, D, C, E, B vitamins.
• Restoration of intestinal microflora - Bifiform, Hilak.

In addition to basic therapy, children should be observed by the attending physician for a year after the onset of the disease. The initial dispensary examination is carried out 2 weeks after the end of the course of treatment, then repeated examinations are needed every 3 months.

Treatment of hepatitis B in children is possible both in hospital and at home, everything depends on the severity of the process, age and individual characteristics of the child's body.

Treatment of hepatitis B

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Prevention of hepatitis B in children

Preventive measures against hepatitis infection are divided into specific and non-specific. Non-specific measures include following the following rules:

• Compliance with personal hygiene rules by both adults and children. This is especially important in families where carriers of the virus have been identified.
• It is necessary to monitor the use of disposable instruments when taking a child to the dentist, for vaccinations, when injecting medications, and so on.
• An expectant mother is required to be tested for hepatitis B, as well as for other diseases, when planning a pregnancy.
• Timely detection of infected patients, including people suffering from hepatitis in a latent form. This requires widespread systematic medical examination.

The most effective prevention of hepatitis B in children is vaccination, which has no age restrictions or contraindications and is carried out immediately after the child is born.

How to prevent hepatitis B?

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Vaccination of children against hepatitis B

Vaccination of children against hepatitis B is a reliable and guaranteed protection against infection, it is carried out in three stages and is aimed at the formation of specific substances in the body (antibodies) that are able to resist the virus. The reliability of vaccination is 98-99%, immune protection lasts from 7 to 10 years, but most often persists throughout life. In many countries, vaccination of children against hepatitis B and other viral diseases is included in the mandatory state program for the protection of public health. As a rule, vaccinations are carried out according to the following scheme:

• Primary vaccination – immediately after birth, in the first hours of life.
• Second administration of the vaccine – age 1 month.
• Third vaccination – 6 months of age.

If a pregnant woman is a carrier of the virus or falls ill during pregnancy, the baby is vaccinated according to a more complex scheme. Children who somehow avoided timely scheduled vaccination are vaccinated at the age of 12 to 13 years.

As a rule, the vaccine, regardless of whether it is imported or domestic, is tolerated by children without consequences. Possible side effects:

• Redness or swelling where the vaccine was administered.
• A slight increase in temperature is possible - up to 37.5 degrees.
• A rash in the form of urticaria is extremely rare.

Vaccination of children against hepatitis B has some contraindications:

• Premature newborn (premature birth), weight up to 1.5-1.8 kilograms.
• Acute inflammatory diseases or exacerbation of chronic diseases.
• Intolerance to yeast substances.
• Some neurological pathologies in newborns.

Basically, all children are vaccinated, since the benefit-to-complication ratio is simply not comparable with the high risk of hepatitis B infection.

Prognosis of hepatitis B in children

Hepatitis B differs from other hepatitis viruses by its high contagiousness and a high percentage of fatal outcomes if treatment is not started in a timely manner. The most dangerous is the latent form, which can develop into cirrhosis and cancer in the liver. If all appropriate preventive measures are taken, including vaccination, the prognosis for hepatitis B in children is quite favorable. Recovery from acute hepatitis occurs a month after the onset of the disease, the child can be considered completely healthy after a year if laboratory tests do not detect the presence of the HBsAg antigen in the blood. Usually, with effective treatment and compliance with all recommendations, about 90% of children fully recover. This is due to the widespread early vaccination of newborns, thus reducing the percentage of fatal outcomes to a minimum (less than 1%). An unfavorable prognosis for hepatitis B in children is possible with a malignant course of the disease and the presence of congenital internal pathologies.

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