Viral Hepatitis in School-Aged Children
Lance Chilton MD1
1 Associate Professor of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131
Hepatitis A is a common disease in children, usually passed by the fecal-oral route. Because of its route of transmission, day care centers, especially those caring for infants and toddlers in diapers, are a likely site of passage of the disease, unlike schools, where transfer of HAV occurs uncommonly. The pediatrician encountering a case of HA must ascertain (1) that other possible aiagnoses have been eliminated, (2) whether the patient or a sibling attends a day care center, and (3) the likelihood of a common source outbreak associated with contaminated food or drink. Public health help should be sought to determine that all wider implications of the patient's disease have been taken into account. In some instances, immunoglobulin use may be indicated beyond the usual group of family and sexual contacts. In many cases, the pediatrician will be asked to stretch the indications for immunoglobulin prophylaxis; the forces may be so strong as to force mass immunoglobulin administration even if inschool transmission is unlikely. There is no specific treatment for hepatitis; previously prescribed diets and restrictions of activity are unnecessary. Recovery without complications occurs in the vast majority of patients, especially children, with HA.
Hepatitis B and non-A, non-B hepatitis are less common than HA in children, except those in certain groups. Those infected have a 10% likelihood of contracting chronic active hepatitis; with HB, a chronic carrier state contributes substantially to the epidemiology of the disease. The same is likely to hold true for non-A, non-B hepatitis. In patients with needle-stick, blood product, or sexual xposure to HB, standard immunoglobulin or HBIG is recommended as prophylaxis; for those exposed to NANB, immunoglobulin may be given. A vaccine to give active protection against HB exists; one is being developed for HA as well.
