Hepatitis A in children

Hepatitis A is an acute, cyclically occurring disease caused by an RNA-containing virus; characterized by short-term symptoms of intoxication, rapidly passing violations of liver functions with benign flow.

Hepatitis A is not accidentally considered a child's disease, most often they are sick children up to 14-15 years. This prevalence is associated with the specifics of child behavior, the basis of which is normal curiosity and search activity. In games, games, children simply do not notice either dirty hands or contaminated 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 safely, but severe forms also occur, mostly they are diagnosed in this category of children: 

• Newborn children.
• Children with weakened immunity.
• Children who have concomitant acute illnesses 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 six months. During this period, the child is required to maintain a sparing diet and to limit physical activity, motor activity.

ICD-10 code

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

Epidemiology of hepatitis A in children

Epidemiology of HAV in children is characterized by the mechanism of virus entry into the body. The way of spreading one is fecal-oral, when the infection gets into the gastrointestinal tract with food, water, but more often with the help of dirty, unwashed hands.

Mass outbreaks of contamination through food are possible in children's institutions if children simultaneously consume food or water contaminated with the virus. Some experts put forward a version about the airborne, parenteral and vertical pathways of infection. In clinical practice, such cases have actually been noted, but they are the exception to the rules rather than the typical conditions of infection, and are extremely rare.

The main reservoir of infection is a person infected with a virus, both a child and an adult. HAV virus is excreted in fecal masses, in urine and blood before the appearance of jaundice, the maximum activity of hepatitis appears in the pre-zheltushnom period. As soon as the sclera of the eyes, the integuments are colored in a characteristic yellowish hue, the secretion of the HAV virus ceases. Thus, the contagious nature of hepatitis is a danger in the first two to three days of the disease, 10-14 days after the end of the incubation phase, the sick child can be considered not dangerous in terms of spreading the infection. It is believed that the epidemiology of hepatitis A is not related to seasonality, but a small percentage increase in the number of diseases is observed 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 for the world community, more than 80% of the total number of patients with hepatitis A are children between the ages of one and fourteen years.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes of hepatitis A in children

The reason why children often suffer from hepatitis A is an extremely active and persistent pathogen - Hepatitis A virus, which belongs to the genus of enteroviruses of a huge family of picornaviruses. According to the latest data provided by microbiologists and infectious disease specialists, there are more than 220 types of viruses in this family. The chromosome genetic set (genome) of HAV consists of one, an RNA-containing molecule and four 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 90% of it is found in the feces. Possessing high resistance to the influence of various factors, including the acid medium, the causative agent of the infection is able to remain in a dry room or on products at a favorable room temperature for several weeks and even months. In feces, the pathogen is able to live 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 baby's stomach through the mouth, the passage of the barrier of the intestinal mucosa and ingestion into the liver cells by blood flow. In the liver, the causative agent of hepatitis begins to multiply, replicating with hepatocytes. The 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 jaundiced stage of the disease comes, the process of convalescence (recovery) begins, this is explained by the timely active response of the child's immune system to the intrusion of the HAAg antigen. The more active the immune system, the faster the liver cells damaged by the virus are destroyed and removed from the body, and the jaundiced shade of the baby's skin becomes more pronounced. In addition to immunity, the liver itself also participates in the fight against infection, it tries to restore the lost cells and regenerates.

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

What causes hepatitis A?

[12], [13], [14], [15], [16], [17],

Symptoms of hepatitis A in children

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

• Acute form with jaundice.
• Subacute form without jaundice.
• Subclinical form of the disease, which occurs almost asymptomatically.

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

• The incubation period.
• The initial (prodromal) stage.
• Pre-zheltushny period.
• Jaundice.
• Post-jolly period.
• Recovering (convalescence).

1. Incubation of the virus takes no more than 15 days. The period is asymptomatic. In the blood test, a specific antigen and a high activity of the enzymes - ALAT and ASAT - are detected. 
2. Pregnant period is the first sign of infection. Symptoms of hepatitis A in children at this stage are usually pronounced and are manifested by high fever, headache, nausea, and lack of appetite. Vomiting occurs after eating and can bring some relief, however, nausea quickly returns and there is a characteristic pain in the region of the liver. On the part of the gastrointestinal tract, flatulence, dyspepsia, diarrhea or constipation is possible. After two or three days, the child's condition improves slightly, the body temperature returns to normal, but there are signs of dyspepsia, fatigue and fatigue. Cal and urine begin to acquire an atypical color - the feces are depigmented and the urine darkens. This is one of the most obvious symptoms of hepatitis, which parents should pay attention to. Also, this sign is an occasion for immediate treatment to the doctor and for passing through all the necessary stages of the examination. Such actions are connected with the fact that hepatitis A in children can occur in an atypical form, without fever and pain in the liver, so urine and feces are often the only characteristic symptoms of infection. 
3. Jaundice is the coloring of the whites of the eyes, face, neck, hands and whole body in a typical yellow color for hepatitis. The more acute the disease, the more actively the immune system fights against it, the more yellowness will be expressed. General health of the child at this stage can be called normal, despite the increase in the liver. In the icteric period, the color of the feces and urine changes, and the blood counts (liver tests) show obvious deviations from the limits of the norms from bilirubin, protein and transaminases. The end of the icteric period is a significant improvement in the child's well-being, when he has a good appetite, he is active, well asleep. Also a sign of the completion of jaundice may be the return of normal color of feces and urine. 
4. The recovery stage is a process of restoration of the liver function, so with relatively normal health indicators the child will become more tired and periodically complain about pain in the right hypochondrium region. The period of convalescence can last from 2 months to 6 months, it all depends on the degree of liver damage.

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

Symptoms of hepatitis A

Vaccination against hepatitis A in children

In many developed countries, vaccination against hepatitis A in children is a normal planned exercise, considered mandatory. In the CIS countries, immunization against HAV has not yet been included in the list of mandatory vaccinations, but almost all pediatricians persistently recommend that the child be vaccinated before beginning a visit to preschool or school. It is in places of large concentrations of children and adolescents that there is a risk of infection with hepatitis. Vaccination against hepatitis A in children should be done in advance - for 10-14 days before possible contact with the virus. In addition, it is recommended to vaccinate children who go to school camps for summer vacations, to a sanatorium or to rest with their parents in countries with a high epidemiological level of infection. Also, vaccination is needed for children whose parents (or parent) are ill with hepatitis A, the introduction of the vaccine will be effective in the first week after contact with the sick person.

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

Immunity after vaccination has been maintained for a minimum of 6 years, to date the pharmaceutical industry provides several options for drugs that allow to form a stable immune defense against hepatitis A within 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 the clinical signs of the disease, which the parents of the child should pay attention to. 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 can not always accurately describe his feelings: he quickly switches, distracted from uncomfortable manifestations, and sometimes completely and completely forgets about them. On the one hand, it helps children overcome the disease more quickly, unlike adults, on the other hand it presents a certain difficulty in determining the typical external signs of hepatitis, especially in the initial, jaundiced period.

Attentive parents immediately note the loss of appetite, nausea, subfebrile body temperature in your child. These manifestations, of course, are non-specific, nevertheless should cause concern among caring parents - mother or father.

Diagnosis of hepatitis A in children - this is the conduct of laboratory research, which are divided into specific and nonspecific.

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

Nonspecific diagnostics consists in assessing the liver, determining the parameters of its functions and the degree of damage. Methods of nonspecific study - a general and biochemical blood test, urinalysis.

Treatment of hepatitis A in children

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

The therapeutic complex, aimed at treating hepatitis A, includes such purposes.

Gentle motor mode. Strict bed rest - in the first 7-10 days, after the end of jaundice, when the child's condition is normal, it is possible to limit the motor activity (walks). Excluded are playing sports, outdoor games for six months.

Compliance with diet (table number 5 or 5a for Pevzner). All sharp, fried, fatty meals are excluded. Allowed are dairy products that have been heat treated, low-fat varieties of fish, meat, steamed or baked. Also on the menu can include porridge, pasta, potatoes, compotes of dried fruits, salads in vegetable oil, jelly. The ratio of proteins, carbohydrates and fats is 1/4/1. In addition, the therapeutic diet includes abundant alkaline drink (mineral water).

Reception of cholagogue broths and herbal preparations.

Reception of vitamin and mineral complexes. Particularly effective are vitamins of group B, vitamins C, E and PP, antioxidants.

The appointment of a limited list of medications - hepatoprotectors on a plant basis. Also decoctions of cholagogue grasses - immortelle, sporish, corn stigmas are effective.

Treatment of hepatitis A in children - this is a dispensary record, observation during the recovery period. Such measures help to eliminate recurrences of the disease, accelerate the process of rehabilitation and restoration of liver function. The first dispensary examination (visit to the doctor) should be held no later than, 40 days after the start of the disease, a secondary examination can be carried out after three months. After 6 months the dispensary registration is terminated, and the child can be considered quite healthy.

Treatment of hepatitis A

Prevention of hepatitis A

Preventive measures to prevent HAV infection are compliance with sanitary and hygienic rules, especially in the sense of personal hygiene. Prevention of hepatitis A in children is entirely related to the actions of parents. The earlier a mother learns a baby to wash her hands and begins to instill in him the habit of keeping clean, the less will be the risk of contracting hepatitis and other foodborne infections. There are many game forms for such training, in addition, many pre-school establishments hold special classes dedicated to personal hygiene. Also parents should regularly explain to children the harm of using unwashed raw fruits and vegetables. Of course, it is impossible to introduce total control over the actions of curious toddlers, as well as 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

Dispensary supervision

After the end of the acute period, all children are subject to mandatory dispensary supervision. It is better to conduct medical examination in a special office organized at the hospital. If it is impossible to organize such an office, the district pediatrician in the children's polyclinic should conduct the prophylactic examination.

The first examination and examination of the child is carried out on 45-60 days from the onset of the disease, the second - after 3 months. In the absence of residual phenomena, the convalescents are removed from the account. If there are clinical or biochemical signs of process incompleteness, follow-up is carried out until complete recovery.

Dispanserization of convalescents. Living in rural areas, are carried out at the infectious departments of the central district children's hospitals and in children's polyclinics.

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Prognosis of hepatitis A in children

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

According to statistics, the beginning of recovery after a month is fixed in 70% of affected children, after 2-3 months almost 80% of children do not have post-infection symptoms, after half a year, 90-95% of small patients recover completely. A small number of children (2-3% of all cases) noted the preservation of asthenovegetative symptoms or post-hepatitis phenomena, but these are isolated cases, which are the exception and are explained by the presence of concomitant pathologies, including congenital ones.