Pediatric Hepatitis

Question 1

Types of hepatitis viruses

Answer 1

1. hepatitis A
2. hepatitis B
3. hepatitis C
4. hepatitis D
5. hepatitis E

Question 2

symptoms of hepatitis in children

Answer 2

1. poor appetite
2. diarrhea
3. constipation
4. belly pain
5. tiredness
6. hepatomegaly
7. jaundice
8. high liver enzymes

Question 3

Causes of hepatitis in child

Answer 3

1. may never find cause
2. Epstein-Barr virus
3. cytomegalovirus

Question 4

Hepatitis A in children

Answer 4

Picornavirus;
highly contagious;
vaccination occurs as an infant

Question 5

hepatitis A in children: transmission

Answer 5

spread through person-to-person contact and fecal-oral so can spread through households or daycare centers

Question 6

hepatitis A in children: remember what about asymptomatic children

Answer 6

can still spread virus when asymptomatic

Question 7

how are symptoms different in children and older child/adult

Answer 7

older children and adults have more severe symptoms

Question 8

where in the US is hepatitis A most common

Answer 8

western and southern US

Question 9

How long is hepatitis A infection contagious

Answer 9

for 1-3 weeks:

1. one to 2 weeks before onset of illness;
2. one week after onset of jaundice

Question 10

What is the incubation period for hepatitis A infection in child

Answer 10

15-50 days

Question 11

What are the 2 phases of hepatitis A

Answer 11

1. preicteric phase

2. jaundice phase

Question 12

Preicteric phase of hepatitis A: symptoms

Answer 12

1. Fever;
2. nausea;
3. vomiting
4. digestive complaints
5. abdominal complaints
   * phase may be missed in children

Question 13

Jaundice phase of hepatitis A

Answer 13

1. occurs after preicteric phase;
2. urine darkens and stools become clay-colored;
3. diarrhea in infants;
4. constipation in older child
5. poor weight gain;
   * can last 1-6 months with relapse

Question 14

Management of hepatitis A in child

Answer 14

1. supportive;
2. rarely causes liver failure
3. most recover fully

Question 15

Hepatitis A vaccine after exposure in peds

Answer 15

1. if > 12 months: vaccinate within 2 weeks of exposure

2. if < 12 months or over 40 years, immunocompromised, or chronic liver disease: administer gamma globulin

Question 16

Primary prevention of hepatitis A

Answer 16

Vaccination:

1. children born after 2006 have been vaccinated
2. born before 2006 vaccinate only by risk

Question 17

Two cohorts of children with hepatitis B

Answer 17

1. children born with it

2. children who acquire it later in life {rare}

Question 18

If mother is HBsAg positive, the risk of transmission is what percent

Answer 18

70-90%

Question 19

Pregnancy and hepatitis B

Answer 19

1. screen all pregnant women
2. breastfeeding not contraindicated
3. important to provide immunoglobulin and vaccination to baby immediately after birth

Question 20

When should a baby’s antigen and antibody levels be checked

Answer 20

2-3 months after vaccination

Question 21

hepatitis B in premature infants

Answer 21

1. limited immune response
2. if birthweight is < 2000 g and mother is HBsAg positive or unknown, give both Hepatitis B and Hepatitis B immunoglobulin {HBIG} at birth
3. vaccinate again at 1 month

Question 22

screening for hepatitis B

Answer 22

1. consider screening anyone at any age whose mother might not have been tested during pregnancy;
2. most commonly those born outside US

Question 23

Hepatitis B treatment for newborns whose mother are hep B surface antigen or unknown

Answer 23

1. within 12 hours of birth administer HepB vaccine regardless of birth weight;
2. If infant is < 2000g then administer HBIGin addition
3. administer second dose right at 1 month
4. administer third dose at 6 months
   * *timing is critical

Question 24

when should newborn be tested for hepatitis B surface antigen and antibody

Answer 24

2 months after 3rd dose is administered

Question 25

What should lab work look like if treatment for hepatitis B was successful

Answer 25

antibody positive and antigen negative

Question 26

Primary prevention of hepatitis B

Answer 26

1. vaccinate all neonates
2. test all pregnant women and those at high risk
3. administer catch-up vaccine for teens before college
4. test others who are risk
5. test those whose mother may not have been screened

Question 27

two cohorts of hepatitis C

Answer 27

those born with it

those who acquire it

Question 28

what population have higher risk of hepatitis C

Answer 28

1. IV or intranasal drug use;
2. imprisonment
3. occupation
4. sexual exposure
5. transfusions

Question 29

Which group have an increased risk of Hepatitis C without no known risk factors

Answer 29

baby boomers

Question 30

what children are at risk for hepatitis C

Answer 30

1. child with hemophilia
2. children with HIV positive mom {largest cohort};
3. children with mothers with hep C

Question 31

What should be done if you identify a Hepatitis C positive child or teen

Answer 31

1. repeat antibody testing - can be false positives
2. screen for risk factors
3. draw viral load {RNA}
4. check liver function tests
5. refer to hepatitis center

Question 32

child with chronic hepatitis C is treated how

Answer 32

same as adult

Question 33

Babies who are exposed to hepatitis C will retain mother’s antibodies for how long

Answer 33

12-18 months

Question 34

When is a child pronounced as cleared of hepatitis C

Answer 34

if they test negative after age 18 months

Question 35

When should you test for hepatitis C RNA {NAAT test}

Answer 35

at age 1-2 months

Question 36

Management of hepatitis C in child

Answer 36

1. vaccinate against other hepatitis viruses
2. track growth- interferon and ribavirin can decrease growth markedly
3. avoid other hepatotoxic meds
4. teach alcohol avoidance
5. provide long-term surveillance for liver cancer/failure