Hepatitis B

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The liver is an organ that is part of our digestive system. It helps us get rid of toxins, digest food, and store energy from food.

What is Hepatitis?

Hepatitis B is liver disease caused by a virus.

The liver is an organ in our abdomen (belly). It helps our bodies remove toxins and waste. It also helps us digest food and store the energy we get from food.

The word “hepatitis” means that there is inflammation of the liver. Inflammation of the liver can affect the liver’s ability to work properly. Hepatitis can be caused by infections (virus, bacteria or parasites), drugs or toxins (including alcohol). There are several types of viruses that can cause hepatitis. One of these viruses is the hepatitis B virus. The hepatitis B virus is sometimes referred to as HBV.

How do people get hepatitis B?

People may get the hepatitis B virus if they come in contact with the blood or other bodily fluid of someone who has hepatitis B. The virus then infects the liver.

Here are some ways that children can be infected with the hepatitis B virus:

  • Most children with hepatitis B were born to mothers who are also infected with the virus. The hepatitis B virus is passed to the baby either during pregnancy or delivery. It is possible to lower the risk of infection for the baby by using medicines and vaccination. This is why all pregnant women should be tested for hepatitis B during pregnancy. It is safe for a woman with hepatitis B to breastfeed her child because the virus does not pass through breast milk. However, if a mom has cracked and bleeding nipples, she should discuss breastfeeding with her health-care provider.
  • Very rarely, children can get hepatitis B if they share personal items that may have the blood of someone with hepatitis B on them (such as toothbrushes, nail clippers or razors). The virus on these items may get into the children’s bodies through tiny cuts and openings on the skin.
  • Children can get hepatitis B if they use needles that are contaminated with the hepatitis B virus. This happens when they use the same needles that were already used by someone with hepatitis B. This includes body piercing, tattooing, acupuncture, accidental needle stick injuries or intravenous drug use.
  • The chance that a child can get hepatitis B from blood transfusion or organ transplantation in Canada is extremely small. All blood products and donated organs are tested for hepatitis B infection before they are given to patients. In some other parts of the world, this is a more common problem.
  • Anyone can get hepatitis B by having unprotected sexual contact with someone who has hepatitis B. It is important to know that children with hepatitis B can live normally. Many people live their whole lives with hepatitis B without significant damage to their liver because of the virus.

How easily can hepatitis B be spread to other people?

The risk of getting hepatitis B infection is very low in regular day-to-day activity. If someone in your home has hepatitis B then all other people living there should be immunized against it.

If your child has hepatitis B, they should not share personal items that may have traces of blood on them (toothbrush, nail clippers or razors). Your child should be taught not to let other people touch their blood if they have an accident, and they should not touch the blood of others.

Because the amount of virus in saliva is low, the risk to pass the virus is minimal. It is unnecessary to have two sets of eating utensils or dishes at home. Your child and the rest of the family can safely use the same sets.

There is no risk of passing the virus to others by:

  • breastfeeding, unless you have cracked and bleeding nipples. In this case, discuss the problem with your health-care provider. They may advice you to use breast shields or to stop breastfeeding.
  • sneezing and coughing around other people
  • hugging and kissing

To protect your child’s health and others’, it is important to teach your child about good general health routines such as washing their hands and not touching blood and bodily fluids. It is best to inform your child of their hepatitis B status when they are mature enough to understand the information. Talk to your child before they start to have romantic relationships or be tempted to experiment with alcohol or drugs. Teenagers should be taught about the importance of practicing safe sex, including the use of condoms, to reduce the risk of passing on hepatitis B to others.

Signs and symptoms of hepatitis B

Acute Hepatitis

Many people who become infected with hepatitis B, especially children, do not have any symptoms at the time of infection and never feel sick. Others get a brief illness with fatigue, decreased appetite and their eyes may turn yellow (jaundice).

Chronic Hepatitis

A hepatitis B infection that lasts for more than six months is called chronic hepatitis. Infants and young children infected with hepatitis B have a high likelihood of developing chronic hepatitis. Most teenagers and adults are able to clear the virus on their own and develop life-long protection against it. Almost all children with chronic hepatitis B have no symptoms and grow normally.

Tests for diagnosis and monitoring of hepatitis B

If you or your healthcare provider thinks that your child is at risk for hepatitis B, your child can be tested with blood tests.

Hepatitis B serology

Serology is the study of the blood and its content in particular immune system components. The first test your child will have looks for markers in the blood indicating that they have hepatitis B. The test looks for surface components of the outer “coat” of the hepatitis B virus. These components are called antigens. If this test is positive, this means your child has hepatitis B infection. If it continues to be positive for longer than six months, this means your child has chronic hepatitis B.

Your child may also have a test that looks for the specific reaction of the immune system to the hepatitis B virus. The immune system makes antibodies that recognize the hepatitis B surface antigens. This test measures the protective antibodies that your child developed against the hepatitis B virus. A positive result may mean that your child is immune to the hepatitis B virus, either because they have recovered from a past infection or received the vaccination.

Viral load

A second test may be used to see what amount of hepatitis B virus is present in your child’s blood. This is called the “hepatitis B viral load”.

Liver enzymes

Blood tests called ALT and AST (liver enzymes) tell how active the disease is and other blood tests indicate if the liver is working properly.

Monitoring hepatitis B

Many children have a high viral load because their immune system does not recognize and control the hepatitis B virus. As long as the liver enzymes are normal and your child has regular checkups, a high viral load is common and does not mean your child will be unwell.

High levels of liver enzymes in your child’s blood usually mean that your child’s immune system has recognized the virus and is trying to fight it. The immune system may eventually be able to reduce the amount of hepatitis B virus in the blood. This is good because it means the risk of damage to the liver from scarring because of hepatitis B is reduced.

This inflammation of the liver may go away on its own over a short period of time without causing a reduction in the amount of the virus in the blood. In children where the liver enzymes are high for a long time (six to 12 months) your doctor may recommend treatment to help stop the inflammation in the liver before scarring can develop.

Many people live their whole lives without significant damage to their liver due to hepatitis B. However as people age, the risk of scarring in the liver increases. Mild scarring in the liver does not usually affect the way the liver works. Severe scarring (cirrhosis) may make it difficult for the liver to work properly. Cirrhosis only rarely happens in children with hepatitis B. Chronic hepatitis B infection also increases the risk for liver cancer, especially if it has caused bad liver scarring. Liver cancer is very rare in children with hepatitis B.

It is important that your child have regular medical follow-up throughout life. This allows problems in your child’s liver to be identified and treated early, which may prevent or delay development of liver scarring or cirrhosis and liver cancer.

Treatment for hepatitis B

There is currently no cure for hepatitis B. For chronic hepatitis B there are medications which may reduce the amount of inflammation and/or damage the virus may cause to the liver. If your child’s hepatitis B is chronic and progressing or if there are other health problems, your doctor may recommend medication to treat the hepatitis B infection.

For acute hepatitis B infection, there are no medications. Treatment will help relieve symptoms.

Immunization

As for any illness, the best treatment is prevention. There are very effective vaccines to prevent hepatitis B. In Canada, this vaccine is part of the Routine Immunization Schedule. This means that all children are protected against hepatitis B if they get all their required shots from the doctor or at school. Children and teenagers are immunized at various ages depending on the province in which they live.

When a pregnant woman has hepatitis B, sometimes she needs to take medication to lower her viral load before delivering her baby. When the baby is born, they receive the first dose of the hepatitis B vaccine and another medicine to protect them from the virus. This medicine is called the hepatitis B immune globulin or HBIG. The baby will need at least two additional doses of the hepatitis B vaccine at one month and six months of age.

How to care for your child at home

Many people live their whole lives with hepatitis B but do not experience significant damage to their liver. However, the risk of scarring in the liver increases with age. That is why if your child has chronic hepatitis B, your healthcare provider will see your child regularly.

Who to tell about your child’s hepatitis B status?

It is up to you who you tell about your child’s hepatitis B infection.

You should tell people who look after your child’s general health, like dentists, doctors and nurses.

Sometimes people who work with children, including teachers, sports coaches and other volunteers do not really know about hepatitis B. In some communities there may be a stigma associated with hepatitis B infection. Therefore, you may wish to discuss strategies with your child’s health-care team before you tell others about your child’s hepatitis B infection.

What can I do to help keep my child’s liver healthy?

There are many things that help your child’s liver stay healthy:

  • A healthy diet​ with plenty of fresh vegetables and fruit helps provide antioxidants that protect the liver from the bad effects of inflammation.
  • Regular physical activity when combined with a healthy diet keeps weight under control. Being overweight will often cause extra difficulty for the liver.
  • Be careful with herbal, natural or other alternative or complimentary treatments. Check with your healthcare provider before giving any herbal medications as some of these may be harmful to the liver.
  • Be careful about other medications. Some medications are processed by the liver. If your child needs medication for other health conditions, it is important to follow the instructions carefully. Ask for advice from your healthcare provider or pharmacist.
  • Get immunized against other infectious diseases. There are no benefits from getting immunized against hepatitis B if your child already has it. Your child should have all of the recommended immunizations available and should be immunized against hepatitis A. However, the rest of the family and care-givers should be immunized against hepatitis B.
  • Explain to your child and/or teen why they should avoid alcohol and other types of drugs which may cause damage to the liver.

Key Points

  • Hepatitis B is an infection due to a virus called hepatitis B virus. You can protect yourself and your family from hepatitis B by getting the proper vaccination.
  • Children can get hepatitis B if they come in contact with the blood or bodily fluids of someone who has hepatitis B. This can happen around the time of birth, by having unprotected sexual contact, contact with contaminated needles or, very rarely, by sharing items which may be contaminated with blood (such as toothbrushes, nail clippers and razors).
  • Hepatitis B cannot be spread to other people by hugging, kissing, sneezing, coughing or breastfeeding. However, if you are breastfeeding and have cracked or bleeding nipples, talk to your health-care team.
  • When the infection stays in the body for a long time, this is called chronic hepatitis B. Many children with chronic hepatitis B will not have any symptoms unless they have developed liver damage.
  • If your child has chronic hepatitis, they should be seen by a healthcare provider regularly to monitor their general health and the health of their liver. As your child gets older, your healthcare provider can help to provide teaching for your child about hepatitis B.

Constance O'Connor​​, NP
Simon Ling, MD​

6/2/2014




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