Hepatitis A in children

Hepatitis A is an acute, cyclical disease caused by an RNA-containing virus; it is characterized by short-term symptoms of intoxication, rapidly passing liver dysfunctions with a benign course.

It is no coincidence that hepatitis A is considered a childhood disease; most often, it affects children under 14-15 years of age. Such prevalence is associated with the specifics of children's behavior, the basis of which is normal curiosity and search activity. In games, fun, children simply do not notice dirty hands or dirty objects, and the desire to immediately bite off an appetizing, albeit unwashed apple, is often irresistible.

HAV or hepatitis A virus is a disease that most often develops quickly and ends well, but severe forms also occur, they are mainly diagnosed in the following category of children:

• Newborn babies.
• Children with weakened immune systems.
• Children with concomitant acute diseases or chronic pathologies.

Hepatitis A in children rarely lasts more than 40 days, but the period of recovery and restoration of liver function can last for six months. During this period, the child needs to follow a gentle diet and limit physical activity and motor activity.

ICD-10 code

• B15 Acute hepatitis A.
• B15.0 Hepatitis A with hepatic coma.
• B15.9 Hepatitis A without hepatic coma.

Epidemiology of hepatitis A in children

The epidemiology of HAV in children is characterized by the mechanism of virus penetration into the body. There is one way of spreading - fecal-oral, when the infection enters the gastrointestinal tract with food, water, but most often with the help of dirty, unwashed hands.

Mass outbreaks of infection through food products are possible in children's institutions if children simultaneously consume food or water contaminated with the virus. Some specialists put forward a version of airborne, parenteral and vertical routes of infection. In clinical practice, such cases have indeed been noted, but they are more an exception to the rule than typical conditions for infection, and are extremely rare.

The main reservoir of infection is a person infected with the virus, both a child and an adult. The HAV virus is excreted in feces, urine and blood before the symptoms of jaundice appear; hepatitis is most active in the pre-icteric period. As soon as the sclera of the eyes and the skin are colored in a characteristic yellowish tint, the excretion of the HAV virus stops. Thus, the contagiousness of hepatitis is dangerous in the first two to three days of the disease; 10-14 days after the end of the incubation period, a sick child can be considered not dangerous in terms of the spread of infection. It is believed that the epidemiology of hepatitis A is not associated with seasonality; however, a small percentage of increase in the number of cases is noted in autumn and winter. If a child successfully overcomes the disease, he develops a strong, reliable immunity against HAV for life. According to statistics provided annually by WHO to the world community, more than 80% of the total number of patients with hepatitis A are children aged from one to fourteen years.

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Causes of Hepatitis A in Children

The reason why children often get sick with hepatitis A is an extremely active and resistant pathogen - Hepatitis A virus, which belongs to the genus of enteroviruses of the huge family of picornaviruses. According to the latest data provided by microbiologists and infectious disease specialists, this family currently has more than 220 types of viruses. The chromosomal genetic set (genome) of HAV consists of one RNA-containing molecule and 4 proteins. The virus does not contain a structural core and is devoid of a shell, all its genotypes have one common antigen - HAAg, which is called fecal, since in 90% of cases it is found in fecal elements. Possessing high resistance to the effects of various factors, including an acidic environment, the causative agent of the infection can persist in a dry room or on products at a favorable room temperature for several weeks and even months. In feces, the pathogen can live for about a month, in water - from six months to ten months. The virus is inactivated by boiling, steaming or ultraviolet radiation.

The cause of hepatitis A in children is the penetration of the hepatitis A virus (HAV) into the child's stomach through the mouth, passing the barrier of the intestinal mucosa and entering the liver cells through the bloodstream. In the liver, the hepatitis pathogen begins to multiply, replicating with hepatocytes. Incubation of this process lasts no more than a month, rarely 40-50 days, during this entire period the destruction of liver cells occurs. When the icteric stage of the disease occurs, the process of convalescence (recovery) begins, this is explained by the timely active response of the child's immune system to the invasion of the HAAg antigen. The more active the immunity, the faster the liver cells damaged by the virus are destroyed and removed from the body, and the more pronounced the yellowish tint of the child's skin. In addition to immunity, the liver itself also participates in the fight against infection, it tries to restore lost cells and regenerates.

The causes of hepatitis A in children are due to almost 100% susceptibility of the body to the virus, but the disease itself is considered relatively mild and most often has a favorable outcome.

What causes hepatitis A?

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Symptoms of Hepatitis A in Children

Symptoms of hepatitis A in children depend on the degree of damage to liver cells and the forms of the disease, which can be as follows:

• Acute form with jaundice.
• Subacute form without jaundice.
• A subclinical form of the disease that is virtually asymptomatic.

A typical hepatitis A disease is characterized by a sequence of five stages:

• Incubation period.
• Initial (prodromal) stage.
• Pre-icteric period.
• Jaundice.
• Post-icteric period.
• Recovery (convalescence).

1. The virus incubation period is no more than 15 days. The period is asymptomatic. Blood tests reveal a specific antigen and high activity of enzymes – ALT and AST.
2. The pre-jaundice period is the first sign of infection. Symptoms of hepatitis A in children at this stage are usually pronounced and manifest themselves as high fever, headache, nausea, and loss of appetite. Vomiting occurs after eating and can bring some relief, but nausea quickly returns and characteristic pain in the liver appears. From the gastrointestinal tract, flatulence, dyspepsia, and diarrhea or constipation are possible. After two or three days, the child's condition improves slightly, the body temperature returns to normal, but signs of dyspepsia, weakness, and fatigue remain. Feces and urine begin to acquire an atypical color - feces are depigmented, and urine darkens. This is one of the most obvious symptoms of hepatitis that parents should pay attention to. This symptom is also a reason to immediately contact a doctor and undergo all the necessary stages of examination. Such actions are related to the fact that hepatitis A in children can occur in an atypical form, without fever and pain in the liver area, so urine and feces are often the only characteristic symptoms of the infection.
3. Jaundice is the coloring of the whites of the eyes, face, neck, hands and the whole body in a yellowish tint typical of hepatitis. The more acute the disease, the more actively the immune system fights it, the brighter the yellowness will be. The general health of the child at this stage can be called normal, despite the enlargement of the liver. During the jaundice period, the color of feces and urine changes, and blood tests (liver tests) show clear deviations from the normal range in terms of bilirubin, protein and transaminases. The end of the jaundice period is a significant improvement in the child's well-being, when he has a good appetite, he is active, sleeps well. Also, a sign of the end of jaundice can be the return of the normal color of feces and urine.
4. The recovery stage is the process of restoring liver function, so with relatively normal health indicators, the child will be tired more often and periodically complain of pain in the right hypochondrium. The recovery period can last from 2 months to six months, depending on the degree of liver damage.

Symptoms of hepatitis A in children are usually clearly expressed. The atypical form of the disease is more typical for adults than for children. Signs of HAV are especially pronounced in children aged 3 to 10 years, which makes it possible to diagnose the infection fairly quickly and begin symptomatic treatment in time.

Symptoms of Hepatitis A

Hepatitis A Vaccination in Children

In many developed countries, vaccination against hepatitis A in children is a normal routine procedure, considered mandatory. In the CIS countries, immunization against HAV has not yet been included in the list of mandatory vaccinations, but almost all pediatricians strongly recommend vaccinating a child before attending a preschool or school. It is in places with a large concentration of children and adolescents that there is a risk of hepatitis infection. Vaccination against hepatitis A in children should be carried out in advance - 10-14 days before possible contact with the virus. In addition, it is recommended to vaccinate children who are going to school camps for the summer holidays, to sanatoriums or on vacation with their parents in countries with a high epidemiological level of infection. Vaccination is also necessary for children whose parents (or parent) have contracted hepatitis A; the introduction of the vaccine will be effective in the first week after contact with a sick person.

Children usually tolerate the vaccine well, although in some cases mild symptoms of malaise are possible, which are considered an acceptable reaction of the body to the vaccine.

Immunity after vaccination lasts for at least 6 years; today, the pharmaceutical industry offers several types of drugs that allow for the formation of stable immune protection against hepatitis A for 10-15 years after administration.

How to recognize hepatitis A in a child?

Diagnostic criteria that help to identify the HAV virus in a timely manner are clinical signs of the disease, which should be paid attention to primarily by the child's parents. Diagnosis of hepatitis A in children is the collection of detailed anamnestic data, but the specificity of diagnostic measures in this sense is that the child cannot always accurately describe his feelings: he quickly switches, is distracted from uncomfortable manifestations, and sometimes completely forgets about them. On the one hand, this helps children to overcome the disease faster, unlike adults, on the other hand, it presents a certain difficulty in determining the typical external signs of hepatitis, especially in the initial, non-icteric period.

Attentive parents will immediately notice loss of appetite, nausea, subfebrile body temperature in their child. These symptoms are certainly non-specific, but nevertheless should cause concern in caring parents - mom or dad.

Diagnosis of hepatitis A in children involves conducting laboratory tests, which are divided into specific and non-specific.

Specific diagnostics involves determining the antibodies of the immune system, identifying the virus and its antigen. Methods that are used as specific are PCR analysis, immunofermentogram, radioimmunogram.

Non-specific diagnostics consists of assessing the liver condition, determining the parameters of its functions and the degree of damage. Non-specific research methods are general and biochemical blood tests, urine tests.

Treatment of hepatitis A in children

Currently, children with viral hepatitis A are hospitalized extremely rarely, this is due to the fact that the diagnosis is usually made during the icteric stage, when the child does not pose a danger to the family or environment in terms of contagiousness. In addition, treatment of hepatitis A in children in a hospital is a certain stress, both for the nervous system and for the immune system, which is already weakened in the fight against the virus. It is no secret that against the background of reduced immunity, the child's susceptibility to various hospital infections increases. Therefore, if the patient's condition is not severe, home treatment will be optimal.

The therapeutic complex aimed at treating hepatitis A includes the following prescriptions.

Gentle motor regime. Strict bed rest - in the first 7-10 days, after the end of jaundice, when the child's condition normalizes, it is possible to limit motor activity (walks). Sports and active games are excluded for six months.

Diet (table No. 5 or 5a according to Pevzner). All spicy, fried, fatty dishes are excluded. Fermented milk products that have undergone heat treatment, low-fat varieties of fish, meat, steamed or baked are allowed. The menu may also include porridge, pasta, potatoes, dried fruit compotes, salads with vegetable oil, jelly. The ratio of proteins, carbohydrates and fats is 1/4/1. In addition, the therapeutic diet includes abundant alkaline drinks (mineral waters).

Taking choleretic decoctions and herbal preparations.

Taking vitamin and mineral complexes. Vitamins of group B, vitamins C, E and PP, antioxidants are especially effective.

Prescription of a limited list of medications - hepatoprotectors on a plant basis. Also effective are decoctions of choleretic herbs - immortelle, knotweed, corn silk.

Treatment of hepatitis A in children includes dispensary registration and observation during the recovery period. Such measures help to prevent relapses of the disease, speed up the rehabilitation process and restore liver function. The first dispensary examination (visit to the doctor) should take place no later than 40 days after the onset of the disease, a secondary examination can be carried out after three months. After 6 months, dispensary registration is stopped, and the child can be considered completely healthy.

Treatment of hepatitis A

Prevention of hepatitis A

Preventive measures to prevent HAV infection include compliance with sanitary and hygienic rules, primarily in terms of personal hygiene. Prevention of hepatitis A in children is entirely dependent on the actions of parents. The sooner a mother teaches her child to wash his hands and begins to instill in him the habit of maintaining cleanliness, the lower the risk of contracting hepatitis and other foodborne infections. There are many play forms for such training, and many preschools also hold special classes on personal hygiene rules. Parents should also regularly explain to children the harm of eating unwashed raw fruits and vegetables. Of course, it is impossible to introduce total control over the actions of curious children, as well as to completely neutralize possible sources of dirt in the external environment. In this sense, the only reliable prevention of hepatitis A in children is vaccination.

Prevention of hepatitis A

Outpatient observation

After the acute period is over, all children are subject to mandatory dispensary observation. It is better to conduct dispensary observation in a special room organized at the hospital. If it is impossible to organize such a room, the dispensary should be conducted by the local pediatrician at the children's clinic.

The first examination and examination of the child is carried out on the 45-60th day from the onset of the disease, the second - after 3 months. In the absence of residual effects, convalescents are removed from the register. If there are clinical or biochemical signs of incompleteness of the process, dispensary observation is carried out until complete recovery.

The medical examination of convalescents living in rural areas is carried out in the infectious disease departments of central district children's hospitals and in children's clinics.

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Prognosis of Hepatitis A in Children

Hepatitis A is considered one of the relatively mild infectious diseases with a favorable outcome. The prognosis for hepatitis A in children is usually good, since the child's immune system is able to cope with the infection and completely neutralize the virus within 30-40 days without serious consequences for the body.

According to statistics, the onset of recovery after a month is recorded in 70% of sick children, after 2-3 months almost 80% of children have no post-infectious symptoms, after six months 90-95% of small patients fully recover. A small number of children (2-3% of all sick) have persistent asthenovegetative symptoms or post-hepatitis phenomena, but these are isolated cases that are more likely an exception and are explained by the presence of concomitant pathologies, including congenital ones.