Hepatitis is the medical term for liver inflammation. It is not common in children, but a hepatitis outbreak in children in 2022 worried parents and health officials. Nearly 200 hepatitis cases of unknown origin were diagnosed in kids in the United States. Some of the reported cases of children with unexplained hepatitis required liver transplants, and five children died. Please continue reading to learn more about hepatitis symptoms, causes, treatments, and prevention in children.

What causes acute and chronic hepatitis?

Hepatitis is a condition in which the liver becomes inflamed and stops working properly. When the liver inflammation lasts less than 6 months, it is called acute hepatitis. When inflammation of the liver lasts more than 6 months, it is called chronic hepatitis.

Common causes of hepatitis include:

Viral hepatitis: The viral infection can be from hepatitis viruses (hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E). Other causes of viral hepatitis include cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), varicella zoster virus (VZV), enterovirus, parvovirus, adenovirus, and rubella.
Autoimmune hepatitis: When the body’s immune system mistakenly attacks healthy liver cells, it is called autoimmune hepatitis.
Medications: Certain medications can cause liver damage at high doses, for example, acetaminophen. Other medications that can cause drug-induced hepatitis include nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen), birth control pills, anabolic steroids, antibiotics (erythromycin, amoxicillin-clavulanate, tetracyclines, sulfa drugs), certain anti-seizure drugs, statins (cholesterol-lowering medications), and many others.

What are the symptoms of hepatitis in children?

Some children with hepatitis do not develop any symptoms. In others, acute hepatitis can cause gastrointestinal symptoms such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. The child’s symptoms may also include flu-like symptoms, fever, fatigue, jaundice (yellowing of the skin and/or whites of the eyes), itchy skin, light-colored stools, and dark urine. Other common symptoms in children with hepatitis are muscle soreness and joint pain.

How does hepatitis spread in kids?

Common viruses that can cause hepatitis spread in the following ways:

Hepatitis A and E: Contaminated food and drinking water.
Hepatitis B and D: Blood, needles, unprotected sex.
Hepatitis C: Blood, needles.
Epstein-Barr virus (EBV) and cytomegalovirus (CMV): Contact with bodily fluids and secretions.
Adenovirus: Droplets in the air (sneezing, coughing) and contaminated water (for example, in lakes and swimming pools).

Children born to mothers who are infected with the hepatitis viruses (commonly hepatitis B virus) are at risk of getting infected. Pediatric cases of hepatitis can also occur if an infected person does not wash their hands properly after using the bathroom and then prepares food for a child. Hepatitis from contaminated water is a problem in many developing countries but is extremely rare in the US.

Other risk factors for hepatitis include travel to countries where hepatitis A is common. Also at an increased risk of hepatitis are children with disabilities, kidney disease, and blood clotting problems; children who live in long-term care facilities or households where adults are infected; and teenagers who have unprotected sex or use intravenous drugs.

How is hepatitis diagnosed?

Healthcare providers can diagnose hepatitis with blood tests (liver enzymes, liver function tests, coagulation tests, blood counts, polymerase chain reaction and antibody tests to find out the type of hepatitis, and more blood tests). In addition, imaging studies like ultrasound, CT scan, and MRI may be done. A liver biopsy can help to make a definitive diagnosis of hepatitis (this involves removing a small sample of liver tissue and sending it to the laboratory for examination under a microscope).

What to do if your child has hepatitis? How is hepatitis treated?

Most children recover from hepatitis with the appropriate treatment. Treatment of hepatitis in children depends on the underlying cause. For example, if a medication has caused drug-induced hepatitis, the treatment consists of stopping that medication. The choice of treatment also depends on the child’s other coexisting medical conditions.

In addition to supportive care, pediatric gastroenterology specialists may prescribe the following medications for severe cases of hepatitis in children:

What are the complications of severe hepatitis?

Complications of severe hepatitis include cirrhosis (scarring), acute liver failure requiring liver transplant, liver cancer, and death. The risk of these complications is highest with liver disease caused by the hepatitis B and C viruses.

What are the precautions for hepatitis in children?

The Centers for Disease Control and Prevention (CDC) recommends that all children receive the hepatitis A vaccine (2-dose series) and hepatitis B vaccine (3-dose series - this vaccine also protects against hepatitis D).

Other precautions to prevent hepatitis in children include:

Practice good hygiene. Wash your hands thoroughly with soap and water after using the bathroom, after changing a baby’s diapers, and before handling or preparing food and drinks.
Keep all medications safely locked and out of reach of children.
Check the labels on medicines and make sure you give your child the dose appropriate for their age. Do not give medications meant for adults to children without checking with your child’s healthcare provider.
Talk to your child’s healthcare provider about necessary vaccinations before traveling to countries where hepatitis is prevalent.
While traveling overseas, do not drink water from taps unless you are sure it is clean.
Seek prompt medical attention if your child has symptoms such as fever, fatigue, abdominal pain, nausea, vomiting, diarrhea, jaundice (yellowing of the skin or eyes), dark-colored urine, or light-colored stools.

What are some facts about hepatitis in kids?

Hepatitis is an inflammation of the liver that can cause liver damage and lead to liver failure.
Hepatitis in kids can be caused by a common virus (hepatitis viruses or other viruses such as adenovirus, EBV, CMV).
Viral hepatitis can spread through contaminated food and water, blood, bodily fluids, needles, sexual activity, and airborne droplets.
Some kids with hepatitis do not have any symptoms. When present, symptoms of hepatitis include flu-like symptoms and jaundice (yellowish discoloration of the skin and eyes).
You can protect your child against hepatitis by ensuring they get the recommended vaccinations and practicing good hygiene.

References:

https://www.cuimc.columbia.edu/news/hepatitis-outbreak-among-kids-what-parents-should-know
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02517
https://www.mountsinai.org/health-library/diseases-conditions/drug-induced-hepatitis#
https://www.stanfordchildrens.org/en/topic/default?id=hepatitis-in-children-90-P02517
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476329/
https://pubmed.ncbi.nlm.nih.gov/17519457/
https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html#birth-15

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