Hepatitis B in children

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

Each year, more than 50 million new cases of infection are recorded, of which about 2 million people die from complications, more than 400 million earthlings are carriers of the virus, sometimes without even knowing it. Hepatitis B is especially dangerous in children under the age of 2 or 3 years. Most often, HBV (Hepatitus B Virus) affects infants under the age of one year, this is due to epidemiological factors and the vertical route of 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 is parenteral, the disease was even called serum hepatitis. Currently, it has been proven that hepatitis is transmitted through blood only in 45-50% of all diagnosed cases mainly in adults. Children most often become infected by the so-called vertical path.

Ways of contracting hepatitis B in children under one year of age: 

1. Intranatal - in 90% of all diagnosed cases. Infection develops due to the swallowing by the child of the discharge of an infected mother during the passage through the birth canal, due to damage to the mucous membranes, and their contact with infected maternal blood.
2. Transplacental - 6-8% of all recorded diseases. Infection is possible on the background of placental abruption, its dysfunction (FPN - placental insufficiency).
3. Postnatal - 1-2%. This way of transmission of the virus is possible subject to the presence of such factors as the violation of the integrity of the mucous membranes of the child, close contact with an infected mother (care, breastfeeding).

Epidemiology of hepatitis B in children suggests a parenteral (artifactual) path, that is, the penetration of the virus into the blood during medical manipulations (injections, blood transfusions), but such facts are extremely rare, according to statistics they cause an infection of not more than 0.5% 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 (its immune activity). If the virus enters the fetus before the third trimester, the risk of infecting the infant does not exceed 10%, if later, the probability of infection with hepatitis B increases to 70-80%. Intrauterine infection with a virus threatens with premature birth, if the pregnancy can be maintained and the infant is diagnosed as acute hepatitis, the disease in most cases is mild. However, 95% of children remain carriers of the HBsAg antigen for life, creating the 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 the infection with the antigen HBsAg - the outer shell of the main hepatitis B virus, which was previously called the Australian antigen. This marker of hepatitis B can be detected in almost all liquid biological media of an infected person — in lacrimal secretion, in urine, in saliva, in the juice of the stomach, in breast milk, in feces, in pleural or synovial media. The epidemiology of hepatitis B in children is specific in that the virus quickly spreads through all the liquid media in the child’s body and affects the liver parenchyma. The acute form proceeds quickly and most often ends with recovery, while maintaining a strong immunity to the virus throughout life. There are frequent cases of asymptomatic disease progression, when hepatitis develops sluggishly, latently, which can lead to a 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 the sense of infecting others around 3 months; in chronic form, children are considered lifelong virus carriers.

Epidemiology of hepatitis B in children

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The cause of hepatitis B in children

The main source of infection, that is, 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 body of a child are associated with a vertical path of transmission, most often in utero and during labor. It happens that a pregnant woman is a latent carrier of hepatitis B and does not undergo a proper gynecological examination when registering, and hepatitis diagnosed and not immunized in a timely manner during pregnancy can become a serious threat in the sense of infection of the fetus. All other reasons can be 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 by transfusion (blood transfusion).
• Domestic path, which is a rare cause, since hepatitis B is not transmitted by airborne droplets. But if the baby’s mucous membranes or skin is 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, because the virus is not able to be transmitted through milk, however, when feeding, you must monitor the condition of the nipples: they should not have wounds, cracks through which hepatitis can penetrate 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 is greatly increased, therefore, in addition to the fact that each family member must have individual personal belongings, cutlery and follow general safety rules, it is desirable that the whole family passes the vaccination procedure.

What causes hepatitis B?

Symptoms of hepatitis B in children

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

Incubation. This time from the fact of infection to the first clinically manifested symptoms. Incubation can last from 30 days to six months. If hepatitis has penetrated the child’s body in a household way, which rarely happens, the incubation phase lasts for months. In cases where the infection occurs by injection or intranatal, incubation takes less than a month. At this time, hepatitis B does not manifest itself by any of the characteristic signs, it can be detected by laboratory blood tests at random, or if a possible disease is suspected due to infection of the mother. 

The preicteric stage of hepatitis B originates from the very first signs of the disease and develops until the appearance of a specific coloration of the skin and sclera of the eyes. Among the mild clinical symptoms can be identified such: 

• Low-grade body temperature.
• Drowsiness, decreased activity.
• Disturbed appetite.
• Rarely - nausea and vomiting, which are characteristic of the acute form of hepatitis.
• Discoloration of urine, it becomes darker than usual.
• Change the color of feces, it brightens.
• Possible transient abdominal pain.
• Colic, increased flatulence.
• At this stage, the liver thickens and feels palpated as an enlarged, dense organ.

The icteric period of hepatitis B is one of the most pronounced manifestations of a viral disease in the clinical sense. In the yellow tint stained skin, sclera of the eyes, even the mucous membrane of the mouth. The baby’s well-being deteriorates, intoxication develops, the body temperature rises to 38 degrees, and typical right-sided abdominal pain appears. Children are naughty, refuse to eat food, noticeably lose weight. A specific symptom is the smell from the mouth, like the smell of spoiled apples. The icteric stage lasts about a week, sometimes it can stretch to two weeks. The acute form of the disease is accompanied by subcutaneous minor hemorrhages, which, like the symptoms of hepatitis B in children, are not specific. Among cardiac manifestations, a decrease in the level of heart contractions is noticeable, and arterial pressure drops. Neurological symptoms manifested in sleep disturbance, lethargy, apathy. In severe forms of hepatitis, coma is possible. 

The recovery stage begins with the return of the normal color of the skin, that is, from the day when jaundice begins to disappear. The recovery period can be quite long and last up to several months. At this time, children have an appetite, they sleep better, are more active and mobile. The temperature can be kept in the range of 37-37, 5 degrees, but does not interfere with the child to feel 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, after acute hepatitis B, children recover quickly. Chronic disease often occurs in an asymptomatic variant, it is especially difficult to notice the incubation and preicteric 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, as most often the disease is asymptomatic, in an erased form. Only when the icteric stage develops does hepatitis manifest itself clinically, but there are also anicteric variants that are recognized only by the destruction of the liver tissue. Unspecified symptomatology, the absence of a clear clinical picture, especially in newborn babies, leads to the fact that it is necessary to diagnose an already damaged liver in stationary conditions. In this stage, the physician has sufficient anamnestic information, as well as general blood tests, urine tests and an ultrasound examination of the abdominal organs. Biochemical studies of blood serum are needed more to determine the extent of liver damage than to confirm the disease. Diagnosis of hepatitis B in children is important as prevention or recognition of hidden carrier state. In this case, surface antigen (HBsAg) and its antibodies are detected.

[13], [14], [15], [16], [17], [18]

Hepatitis B treatment in children

The main objective of therapy is to maximize the reduction of viral exposure, the load on the liver and other internal organs and body systems. Interferon group is considered the basic treatment.

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

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

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

• Strict diet, table number 5 by Pevzner.
• Limitation of physical activity, activity.
• Interferon therapy.
• Hepatoprotectors of plant origin (Hepatofalk, Hofitol).
• Vitamin therapy - vitamins A, D, C, E, vitamins of group B.
• Restoration of intestinal microflora - Bifiform, Hilak.

In addition to basic therapy, children should be monitored by the attending physician for a year after the onset of the disease. Primary 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 stationary conditions and at home, it all depends on the severity of the process, age and the individual characteristics of the child’s body.

treatment Hepatitis B treatment

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Prevention of hepatitis B in children

Preventive measures against hepatitis are divided into specific and nonspecific. By nonspecific compliance with the following rules: 

• Compliance with the rules of personal hygiene, both adults and children. This is especially true in families where carriers of the virus have been identified. 
• It is necessary to monitor the use of disposable instruments when the child is led to the dentist, to be vaccinated, with injections of medications and so on.
• A future mother is obliged to be tested for hepatitis B, as well as for other diseases, when planning a pregnancy.
• Timely detection of infected patients, including people with latent hepatitis. This requires a widespread systematic medical examination.

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

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%, the immune defense lasts from 7 to 10 years, but most often lasts for a lifetime. In many countries, vaccination of children against hepatitis B and other viral diseases is included in the mandatory public health program. As a rule, vaccinations are carried out according to this scheme: 

• Primary vaccination - immediately after birth, in the first hours of life.
• The second vaccine is 1 month old.
• The third vaccine is 6 months old.

If a pregnant woman is a carrier of the virus or is sick during gestation, the baby is vaccinated according to a more complex pattern. Children who somehow escaped timely routine vaccinations are vaccinated between the ages of 12 and 13.

As a rule, a vaccine, regardless of whether it is manufactured or imported, is tolerated by children without consequences. Possible adverse events: 

• Redness or compaction of the vaccine injection site.
• Perhaps a slight increase in temperature - up to 37.5 degrees.
• Rash in the form of urticaria is extremely rare.

Vaccination of children against hepatitis B has some contraindications: 

• Premature newborn (preterm 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.

In general, all children are vaccinated, as the ratio of benefits and possible complications is simply incomparable with the high risk of infection with hepatitis B.

Hepatitis B prognosis in children

Hepatitis B differs from other hepatitis viruses by its high contagiousness and a high percentage of deaths with delayed treatment. The most dangerous latent, latent form, which can develop into cirrhosis and oncological process in the liver. If all appropriate preventive measures are carried out, including vaccination, then the prognosis of hepatitis B in children is quite favorable. Recovery from acute hepatitis occurs one 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 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 general early vaccination of newborns, thus it was possible to reduce the percentage of deaths to a minimum (less than 1%). Adverse prognosis of hepatitis B in children is possible with a malignant course of the disease and the presence of congenital internal pathologies.

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