Hepatitis B

What is hepatitis B?

Hepatitis means inflammation of the liver. In children the inflammation is usually caused by a viral infection but there are other causes. Hepatitis B is the name of virus which can cause hepatitis.

What does hepatitis B infection do?

Acute hepatitis B infection usually does not cause any symptoms in children. In contrast, infected adults often feel extremely tired and unwell, with loss of appetite, nausea and vomiting, and their skin and eyes may go yellow (jaundice).

The Hepatitis B virus can stay for years in a patient's liver and bloodstream. This is known as chronic hepatitis. Whereas most adults are able to get rid of hepatitis B virus from their body after infection, young children often do not clear the virus from their body and thus have chronic hepatitis B. Most children with chronic hepatitis B infection are well. A child with chronic hepatitis B infection and no symptoms is called a chronic carrier. Carriers can still pass on the infection as they carry the virus but have no symptoms (see below).

How do people catch hepatitis B infection?

The hepatitis B virus is found in the blood and body fluids (saliva, breast-milk, semen, vaginal secretions) of chronic carriers. The commonest way that children are infected is when a pregnant woman, who is a chronic carrier, passes the virus on to her baby during birth.

Adults can become infected from very close personal contact, such as having sex with a carrier, needle sharing or from an infected needle (tattooing or needle stick injury).

Can hepatitis B virus infection be prevented?

Immunisation at any age (from babies to old age) is very effective at protecting people against infection. If it is known (by a blood test) that a pregnant woman is a chronic carrier of hepatitis B, a baby can be immunised (given a vaccine) at birth to protect it from hepatitis B infection. The vaccine does not contain live virus, but contains a protein (called surface antigen) from the virus, meaning you cannot catch hepatitis from the vaccine. However, it is important to understand that immunisation cannot cure someone who is already infected with hepatitis B virus. If a child is found to be a chronic carrier, the family should be tested and immunised if not previously infected or immunised.

If your child does have hepatitis B, you and your family should practise blood awareness. This means being alert to the potential presence of blood from your infected child (e.g. from a wound or a bite) and knowing how to deal with it. It is advisable that your child does not share things like toothbrushes, razors or drink bottles with others. Disposable gloves should be worn when cleaning up any blood or bodily fluids. Remove as much as possible with paper towels, then clean the area with detergent and cold water. Larger spills can be cleaned with bleach.

Do I have to tell the school/day care that my child has hepatitis B?

You are NOT required by law to inform schools and day care that your child has hepatitis B. Schools and day care should always practise standard precautions when dealing with blood and body fluids from any child in their care. This means that they should treat every child's secretions as if they were infectious.

What happens to chronic carriers?

Most chronic carriers of hepatitis B virus remain well all their lives. Up to a quarter of all carriers may develop chronic liver disease (including cirrhosis), a small number of whom may also develop liver cancer. Some carriers get rid of the virus on their own without treatment.

Can chronic carriers be treated?

There is medical treatment for some chronic carriers of hepatitis B, which is mostly given to adults. Children are not usually treated because they are less likely to respond, because treatment may involve a long course of regular injections, and because oral (tablet) therapy is associated with long treatment periods and the development of drug resistance by the virus.

Children with chronic hepatitis B can keep their livers healthy in a number of ways. This includes avoiding alcohol and obesity. They should also avoid injecting drugs as they may be infected with other viruses. It is advisable to be immunised against hepatitis A virus because it can also damage the liver.

Who can I speak to if I want to know more about hepatitis B?

The hospital experts are the gastroenterology team and the infectious disease teams. Most of the experts on immunisation against hepatitis B work at the National Centre for Immunisation Research and Surveillance (NCIRS).

• Immunisation can prevent hepatitis B infection.
• If your child has hepatitis B, practice blood awareness.