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Hepatitis B - children

Silent infection - HBV children; Antivirals - hepatitis B children; HBV children; Pregnancy - hepatitis B children; Maternal transmission - hepatitis B children

Hepatitis B in children is swelling and inflamed tissue of the liver due to infection with the hepatitis B virus (HBV).

Other common hepatitis virus infections include hepatitis A and hepatitis C.

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Causes

HBV is found in the blood or body fluids (semen, tears, or saliva) of an infected person. The virus is not present in the stool (feces).

A child can get HBV through contact with the blood or body fluids of a person who has the virus. Exposure can occur from:

A child cannot get hepatitis B from hugging, kissing, coughing, or sneezing. Breastfeeding by a mother with hepatitis B is safe if the child is treated properly at the time of birth.

Teenagers who are not vaccinated can get HBV during unprotected sex or drug use.

Symptoms

Most children with hepatitis B have none or only a few symptoms. Children younger than 5 years rarely have symptoms of hepatitis B. Older children may develop symptoms 3 to 4 months after the virus enters the body. The main symptoms of a new or recent infection are:

If the body is able to fight HBV, the symptoms end in a few weeks to 6 months. This is called acute hepatitis B. Acute hepatitis B does not cause any lasting problems.

Exams and Tests

Your child's health care provider will perform blood tests called the hepatitis viral panel. These tests can help diagnose:

The following tests detect liver damage and the risk for liver cancer from chronic hepatitis B:

The provider will also check the viral load of HBV in the blood. This test shows how well your child's treatment is working.

Treatment

Acute hepatitis B does not need any special treatment. Your child's immune system will fight the disease. If there is no sign of the HBV infection after 6 months, then your child has recovered fully. However, while the virus is present, your child can pass the virus to others. You should take steps to help prevent the disease from spreading.

Chronic hepatitis B needs treatment. The goal of treatment is to relieve any symptoms, prevent the disease from spreading, and help prevent liver disease. Make sure that your child:

Your child's provider also may recommend antiviral medicines. The medicines decrease or remove HBV from the blood:

It is not always clear what medicines should be given. Children with chronic hepatitis B may get these medicines when:

Outlook (Prognosis)

Many children are able to rid their body of the HBV and do not have a long-term infection.

However, some children never get rid of HBV. This is called chronic hepatitis B infection.

Almost all newborns and about half of children who get hepatitis B develop the long-term (chronic) condition. A positive blood test after 6 months confirms chronic hepatitis B. The disease will not affect your child's growth and development. Regular monitoring plays an important role in managing the disease in children.

You should also help your child learn how to avoid spreading the disease now and into adulthood.

Possible Complications

The possible complications of hepatitis B include:

These complications generally occur during adulthood.

When to Contact a Medical Professional

Call your child's provider if:

Prevention

If a pregnant woman has acute or chronic hepatitis B, these steps are taken to prevent the virus from being transmitted to a baby at birth:

To prevent hepatitis B infection:

References

Centers for Disease Control and Prevention website. Vaccine information statements (VISs): hepatitis B VIS. www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html. Updated August 15, 2019. Accessed January 27, 2020.

Centers for Disease Control and Prevention website. Vaccine information statements: your baby's first vaccines. www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html. Updated April 5, 2019. Accessed January 27, 2020.

Jensen MK, Balistreri WF. Viral hepatitis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 385.

Pham YH, Leung DH. Hepatitis B and D viruses. In: Cherry J, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 157.

Robinson CL, Bernstein H, Romero JR, Szilagyi P. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2019. MMWR Morb Mortal Wkly Rep. 2019; Feb 8;68(5):112-114. PMID: 30730870 pubmed.ncbi.nlm.nih.gov/30730870/.

Terrault NA, Lok ASF, McMahon BJ. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. PMID: 29405329 pubmed.ncbi.nlm.nih.gov/29405329/.

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Review Date: 1/1/2020  

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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