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Understanding The A,B,Cs Of Hepatitis In Children

Usually, treatments in children will focus on supporting the patient’s general condition or reversal of existing damage if possible.

Viral hepatitis is highly preventable with appropriate vaccinations, especially against the Hepatitis A and B viruses. Picture courtesy of Sunway Medical Centre.

KUALA LUMPUR, Sept 5 – Hepatitis is an inflammation of the liver which can be caused by a variety of reasons, including infectious viruses and non-infectious agents. 

Hepatitis viruses are the most common cause of hepatitis in the world, but other infections, drugs, toxins (i.e. alcohol), fatty liver disease or autoimmune diseases can be a cause of hepatitis too.

According to Sunway Medical Centre (SMC) paediatric gastroenterology and hepatology consultant Dr Ong Sik Yong, there are five main strains of hepatitis viruses, namely hepatitis A, B, C, D, and E.

“These hepatitis viruses can all cause hepatitis but they are different in the way how they are transmitted and hence, the prevention methods,” he shared, adding that children are not spared from contracting these viruses.

Usually, treatments in children will focus on supporting the patient’s general condition or reversal of existing damage if possible. Identified toxins or drugs causing the liver disease has to be stopped immediately. 

Most cases of acute hepatitis will resolve over time with treatment. Occasionally, some patients may progress to acute liver failure which can be fatal in a short period of time.  

Hepatitis A does not cause chronic liver disease. On the other hand, Hepatitis B and C can cause chronic infection, and infected patient are at risk of death from liver cirrhosis and liver cancer.

“Children with acute or chronic liver disease will require appropriate medical examination to identify the cause before specific treatment can be offered. There are also certain liver diseases, such as autoimmune hepatitis where certain medications may be used to regulate the over-active immune system which will prevent further attacks on the liver,” says Dr Ong.

Knowing When To Seek Medical Advice

In acute hepatitis, the virus infection will cause acute inflammation of the liver where the child may experience the following symptoms:

  • Jaundice (yellowing of the skin and eyes).
  • Dark urine.
  • Extreme fatigue.
  • Nausea.
  • Vomiting.
  • Abdominal pain. 
  • Other symptoms may also include fever and/or loss of appetite.

In chronic hepatitis, which can arise from viral hepatitis infections such as Hepatitis B or C, fatty liver disease, drugs or autoimmune diseases, patients are often asymptomatic (shows no symptoms), thus, the disease is only discovered in advance stages and sometimes incidentally through physical examination or blood tests for other illnesses.

That is why, patients with chronic infections are at risk of death from liver cirrhosis (scarring (fibrosis) of the liver caused by long-term liver damage) and liver cancer.

Transmission In Children

There are many ways viral hepatitis can be transmitted. For example, Hepatitis A and E are typically transmitted by faecal oral route where a child may get infected after consuming contaminated food or water. 

“Hepatitis B, C and D however are transmitted via parenteral route – a result of parenteral contact with infected body fluids. The virus is most commonly transmitted from mother to child during birth and delivery, in early childhood, as well as through contact with blood or other body fluids during sex with an infected partner, unsafe injections or exposures to sharp instruments,” according to Dr Ong.

Vaccines And Preventions

With advancements in medicine, viral hepatitis is highly preventable with appropriate vaccinations, especially against the Hepatitis A and B viruses. 

In Malaysia, the Hepatitis B vaccination programme for children was introduced in 1989 and has successfully managed to reduce the seroprevalence of infection among Malaysians to 0.01 per cent.

“All newborn babies are recommended to receive the first Hepatitis B vaccination as soon as possible after birth, preferably within 24 hours of birth, and they should also receive two subsequent vaccine boosters to be completed by six months of age.”

“Additionally, the World Health Organization (WHO) does not recommend booster vaccinations for persons who have completed the three-dose vaccination schedule,” Dr Ong added.

As for pregnant mothers who are Hepatitis B carriers, antenatal antiviral prophylaxis is recommended to prevent mother to child transmission. 

“Furthermore, Hepatitis B vaccination and Hepatitis B immunoglobulin given to newborn babies born to Hepatitis B carrier mothers could help reduce the risk of viral transmission significantly,” says Dr Ong.

Hepatitis A vaccine is usually given from one-year-old onwards with the second dose at least six months after the first dose.

There are currently no vaccines against Hepatitis C, D and E. 

Aside from that, Dr Ong advises against using drugs or supplements with unknown safety profile, consume medication in a way which is not recommended by doctors, as well as inappropriate use of over-the-counter medication as these can lead to liver injury.

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