Physician: Hepatitis A and the Institutionalized Child

Is hepatitis A infection something that I should worry about in my internationally adopted child?

Sonia Billadeau January 30, 2014
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Like hepatitis B & C, hepatitis A is a viral infection affecting the liver, and it generally results in lifelong immunity to the virus. In many developing countries, most children are exposed to the hepatitis A virus early in life. In overt cases of hepatitis A infections, the condition is easily recognized by it signs and symptoms. In the pediatric population, however, a good proportion of children can have the anicteric (without yellowing of the skin) and it can go unrecognized. The majority of children affected with the hepatitis A virus will recover completely, and only a small proportion will go on to develop a more aggressive form of hepatitis.

In children that live in orphanages or day care like setting, the primary means of person-to-person transmission is via the fecal-oral-route. The second method of transmission is by the ingestion of contaminated food or water that has been contaminated with the hepatitis A virus. The major reason why this is a communicable disease is that fact that the virus will shed in an infected child stool for 1-2 weeks before the child even presents any signs or symptoms of disease. Once the signs and symptoms of hepatitis A appear and an accurate diagnosis is made, the viral transmission through the stool decreases. In an orphanage or institution, hepatitis A infection can run rampant, infecting a majority of the cases in a short period of time. Since a majority of the children have asymptomatic disease, during the first two weeks of the illnesses, these children act as a vector to spread the virus to other children and to those who care for the children and change their diapers.

Signs and symptoms of hepatitis A infection are pretty easy to recognize, if they are present:

  1. Gastrointestinal Upset (Poor appetite, vomiting, diarrhea)
  2. Slight fever
  3. Jaundice (yellow skin)
  4. Pain in the region of the liver, right upper quadrant, right below the right rib cage.
  5. Enlarged liver
  6. Dark urine
  7. Light and clay colored stools.
  8. Knowledge of local epidemic in the orphanage.

An attempt to isolate the infected child during the initial phases is indicated in order to reduce the possibility of widespread orphanage epidemic. Unfortunately, by the time the child is diagnosed with the hepatitis A virus, he or she may already be in the noninfectious phases. For the caregivers, it is imperative to handle diapers, stool, and soiled clothing with care in order to not become infected also.

For those exposed and in direct contact with an infected child, an immunization with hepatitis A immunoglobulin can be administered if it is available. Once a child is infected with Hepatitis A, there are no specific therapeutic measures. Generally a very light diet is prescribed: low in fats. This helps to lower some of the gastrointestinal symptoms, but it does nothing to cure the disease. The overall prognosis for children is excellent. There is the very rare instance when a child may have fulminant hepatitis that leads to death.

Currently in the U.S.A. there is a new hepatitis A vaccine. The current recommendations are to begin immunization for all children between the ages of 12 and 23 months. Older children should receive a primary dose followed by a booster dose of hepatitis A six months later. The primary role of any vaccine is to provide immunity to the person that was immunized. A secondary goal is to provide what is called “herd immunity”– when others in the herd or population have been vaccinated, all are protected,  whether or not they have been vaccinated themselves.

Unfortunately, hepatitis A vaccine is not given in a majority of the countries that place children for international adoption. By the time that your adoptive child reaches the United States, he or she will more than likely have already contracted hepatitis A disease and already have immunity to it.

Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child’s situation and or problem. If your child has a specific problem you need to ask your pediatrician about it – only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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Sonia Billadeau


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