Hepatitis B is a virus that attacks the liver. It is a common infection worldwide, and affects about 1.25 million people in the United States. Hepatitis B can cause liver damage (cirrhosis) and liver cancer. Timely and accurate diagnosis, along with medical treatment, can prevent these complications.
Anyone infected with hepatitis B can transmit the virus to other people. The hepatitis B virus is spread from mother to fetus during or after pregnancy (perinatal); and by exposure to blood and bodily fluids including saliva, spinal fluid, and sexual contact. The virus is most concentrated in infected blood, serum, and wound exudates.
The most common ways the virus is spread are through exposure to blood or other bodily fluids of an infected person. The virus can also be spread by activities such as sharing toothbrushes or razors with person who has hepatitis B.
If you or your child has hepatitis B, it is important to make sure that everyone in your household is tested to see if they have the virus since the virus can be easily spread among household contacts. All household contacts should receive the hepatitis B vaccine in order to protect themselves.
A simple blood test ordered by your child's doctor can tell if your child has the infection. Your child's doctor will check to see whether your child has an active infection. It is possible to be infected with hepatitis B virus but not know because many people with the virus do not show any symptoms after contracting the virus. This is why hepatitis B virus infection is often called the "silent infection."
The majority of people infected with hepatitis B virus will not have any symptoms or will not have severe symptoms. Common symptoms experienced by some include:
Some people will experience more aggressive symptoms of infection, including:
Teenagers and adults experience symptoms of hepatitis B virus infection more often than infants and children.
A person who has recently contracted hepatitis B will have an acute infection after a long incubation period. During this time, the infected person may or may not have symptoms of hepatitis B, but is able to pass the virus to others.
If a person has an acute infection, blood work will show a positive test for hepatitis B virus (HBsAg), HBc-IgM DNA and possibly the HBe-antigen. If your child has an acute infection, he or she will need follow-up blood work to determine if your child experiences a total recovery from illness, or if your child has developed a chronic infection.
Six months after exposure, if your child's blood tests are negative for surface antigen and hepatitis B DNA, the acute infection is considered resolved. Once the virus has resolved, your child is now protected from the virus and is unlikely to contract it again. There is no treatment for acute hepatitis B virus infection.
If your child tests positive for hepatitis B virus (HBsAg) over a period more than six months, he or she is diagnosed with chronic hepatitis B infection. This means your child was not able to get rid of the virus during the acute infection stage, and the virus remains in their blood and liver.
Children with chronic hepatitis B can continue to pass the virus to others — even though they may not experience any symptoms of the infection. People with chronic hepatitis B are at an increased risk for developing serious liver problems like cirrhosis or liver cancer.
Treatments are available to slow the progression of the disease and help prevent liver damage in some people. Interferon alpha and Lamivudine were the first two approved treatments for chronic hepatitis B in the United States. Since then, there have been several other effective oral antiviral medications that have been marketed in the U.S.
Treatment can take several years to complete, and not all children with chronic hepatitis B are candidates for treatment. Your child's hepatologist (liver specialist) will determine if your child is a candidate for treatment based on laboratory test results and a physical examination.
In addition to providing care for children with chronic hepatitis B, CHOP's Viral Hepatitis Clinical Care Program also participates in a number of approved and experimental treatment trials for children with chronic hepatitis B. To learn more about treatment options at Children's Hospital and local trials your child may be eligible for, please call 1-866-KID-LIVR (1-866-543-5487).
For information about all clinical trials for hepatitis B, visit www.clinicaltrials.gov.
It is important to remember that children with chronic hepatitis B viral infection can lead normal lives similar to their peers. Unlike some other chronic health conditions, hepatitis B should not interfere with your child's ability to do educational, athletic and social activities.
Transmission of the hepatitis B virus can be prevented. A safe and highly effective vaccine is available. The vaccine is administered as a series of three shots. The recommended schedule for infants is a first dose at birth, second dose between 1-2 months, and third dose between 4-6 months.
For children who didn't receive the vaccine as a baby, a two-dose series is available for teenagers aged 11 to 15 years old. Your child's pediatrician can advise you on the routine vaccination schedule for your child.
People who complete the three-dose series typically have 96 percent immunity from the virus. The vaccine works by creating antibodies to the hepatitis B virus; this means the body becomes immune and cannot catch the virus.
You can learn more about the hepatitis B vaccine at CHOP's Vaccine Education Center.
If you are pregnant and are a carrier of the hepatitis B virus it is very important that you tell your doctor before delivering your baby. If appropriate precautions are taken it is likely that your newborn will not contract the infection perinatally (after birth).
Reviewed by: Jessica Wen, MD
Date: December 2013