Pediatric Hepatitis Flashcards
Types of hepatitis viruses
- hepatitis A
- hepatitis B
- hepatitis C
- hepatitis D
- hepatitis E
symptoms of hepatitis in children
- poor appetite
- diarrhea
- constipation
- belly pain
- tiredness
- hepatomegaly
- jaundice
- high liver enzymes
Causes of hepatitis in child
- may never find cause
- Epstein-Barr virus
- cytomegalovirus
Hepatitis A in children
Picornavirus;
highly contagious;
vaccination occurs as an infant
hepatitis A in children: transmission
spread through person-to-person contact and fecal-oral so can spread through households or daycare centers
hepatitis A in children: remember what about asymptomatic children
can still spread virus when asymptomatic
how are symptoms different in children and older child/adult
older children and adults have more severe symptoms
where in the US is hepatitis A most common
western and southern US
How long is hepatitis A infection contagious
for 1-3 weeks:
- one to 2 weeks before onset of illness;
- one week after onset of jaundice
What is the incubation period for hepatitis A infection in child
15-50 days
What are the 2 phases of hepatitis A
- preicteric phase
2. jaundice phase
Preicteric phase of hepatitis A: symptoms
- Fever;
- nausea;
- vomiting
- digestive complaints
- abdominal complaints
* phase may be missed in children
Jaundice phase of hepatitis A
- occurs after preicteric phase;
- urine darkens and stools become clay-colored;
- diarrhea in infants;
- constipation in older child
- poor weight gain;
* can last 1-6 months with relapse
Management of hepatitis A in child
- supportive;
- rarely causes liver failure
- most recover fully
Hepatitis A vaccine after exposure in peds
- 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
Primary prevention of hepatitis A
Vaccination:
- children born after 2006 have been vaccinated
- born before 2006 vaccinate only by risk
Two cohorts of children with hepatitis B
- children born with it
2. children who acquire it later in life {rare}
If mother is HBsAg positive, the risk of transmission is what percent
70-90%
Pregnancy and hepatitis B
- screen all pregnant women
- breastfeeding not contraindicated
- important to provide immunoglobulin and vaccination to baby immediately after birth
When should a baby’s antigen and antibody levels be checked
2-3 months after vaccination
hepatitis B in premature infants
- limited immune response
- if birthweight is < 2000 g and mother is HBsAg positive or unknown, give both Hepatitis B and Hepatitis B immunoglobulin {HBIG} at birth
- vaccinate again at 1 month
screening for hepatitis B
- consider screening anyone at any age whose mother might not have been tested during pregnancy;
- most commonly those born outside US
Hepatitis B treatment for newborns whose mother are hep B surface antigen or unknown
- within 12 hours of birth administer HepB vaccine regardless of birth weight;
- If infant is < 2000g then administer HBIGin addition
- administer second dose right at 1 month
- administer third dose at 6 months
* *timing is critical
when should newborn be tested for hepatitis B surface antigen and antibody
2 months after 3rd dose is administered
What should lab work look like if treatment for hepatitis B was successful
antibody positive and antigen negative
Primary prevention of hepatitis B
- vaccinate all neonates
- test all pregnant women and those at high risk
- administer catch-up vaccine for teens before college
- test others who are risk
- test those whose mother may not have been screened
two cohorts of hepatitis C
those born with it
those who acquire it
what population have higher risk of hepatitis C
- IV or intranasal drug use;
- imprisonment
- occupation
- sexual exposure
- transfusions
Which group have an increased risk of Hepatitis C without no known risk factors
baby boomers
what children are at risk for hepatitis C
- child with hemophilia
- children with HIV positive mom {largest cohort};
- children with mothers with hep C
What should be done if you identify a Hepatitis C positive child or teen
- repeat antibody testing - can be false positives
- screen for risk factors
- draw viral load {RNA}
- check liver function tests
- refer to hepatitis center
child with chronic hepatitis C is treated how
same as adult
Babies who are exposed to hepatitis C will retain mother’s antibodies for how long
12-18 months
When is a child pronounced as cleared of hepatitis C
if they test negative after age 18 months
When should you test for hepatitis C RNA {NAAT test}
at age 1-2 months
Management of hepatitis C in child
- vaccinate against other hepatitis viruses
- track growth- interferon and ribavirin can decrease growth markedly
- avoid other hepatotoxic meds
- teach alcohol avoidance
- provide long-term surveillance for liver cancer/failure
