What is hepatitis B?

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.

Signs and symptoms

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:

• Loss of appetite
• Fever
• Fatigue
• Muscle or joint pain
• Gastrointestinal (GI) issues such as vomiting and nausea

Some people will experience more aggressive symptoms of infection, including:

• Severe nausea
• Severe vomiting
• Yellowing of the skin or eyes (jaundice)
• Bloating of the abdomen
• Light-colored stools

Teenagers and adults experience symptoms of hepatitis B virus infection more often than infants and children.

Testing and diagnosis

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."

Treatments

There are two types of hepatitis B: acute and chronic. Treatment for each form of hepatitis B differs because of the way your child’s body reacts to the infection.

Acute hepatitis B

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 your child has an acute infection, blood work will show a positive test for hepatitis B virus (HBsAg), HBc-IgM DNA and possibly the HBe-antigen.

Your child will need follow-up blood work to determine if she has 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.

Chronic hepatitis B

If your child tests positive for hepatitis B virus (HBsAg) over a period more than six months, he 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 his 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.

Outlook

Long-term outcomes for children who contract hepatitis B vary. If your child has an acute infection, she will need follow-up blood tests six months after exposure. If those results are negative, the acute infection is over and your child is now protected from the virus and unlikely to contract it again.

If your child’s acute infection leads to chronic hepatitis B, long-term follow up care will be needed to monitor your child’s condition. Even with chronic hepatitis B, you child can lead a relatively normal live compared to his peers, and can be an active participant in educational, athletic and social activities.

Visit the Vaccine Education Center to learn more about hepatitis B and the vaccine.