Hepatitis B is a liver disease caused by the hepatitis B virus (HBV).
Hepatitis B is a form of viral hepatitis that is also known as serum
hepatitis, due to its ability to be spread through body fluids and blood.
HBV can cause lifelong infection, cirrhosis (scarring) of the liver, liver
, liver failure, and death. Hepatitis B is a more severe liver disease
, and asymptomatic infections occur frequently. Chronic hepatitis B
infection may take one of two forms: chronic persistent hepatitis, a
condition characterized by persistence of the virus but in which liver
damage is minimal; and chronic active hepatitis, in which there is
aggressive destruction of liver tissue and rapid progression to cirrhosis
or liver failure.
Transmission of HBV occurs through blood and body fluid exposure such as
blood, semen, vaginal secretions, or saliva. Hepatitis B is not spread
through food or water or by casual contact. Infants may also develop the
disease if they are born to a mother who has the virus. Infected children
often spread the virus to other children if there is frequent contact or a
child has many scrapes or cuts. The common modes of transmission of
hepatitis B are as follows:
Worldwide there are 450 million carriers of hepatitis B, 50 million of
which are in Africa. Carriage rates vary markedly in different areas. In
South Africa, infection is much more common in rural communities than in
According to the Centers for Disease Control (CDC), an estimated 78,000
persons in the United States were infected with HBV in 2001. People of all
ages get hepatitis B, and about 5,000 die per year of sickness caused by
HBV. An estimated 1.25 million Americans are chronically infected, of whom
20 to 30 percent acquired their infection in childhood. It is estimated
that hepatitis B accounts for 20 to 25 percent of all acute viral
hepatitis in children. Infected newborns rarely suffer but have 90 percent
chance of becoming carriers. Twenty-five percent of all HAV positive
newborns develop chronic liver disease by the third to fourth decade of
Causes and symptoms
Hepatitis B is caused by HBV, also called Hepadna virus. The virus has an
incubation period of two to five months. It replicates in the liver, and
virus particles are shed in large amounts into the blood. The blood of
infected individuals is thus highly infectious.
Hepatitis B has a wide range of symptoms. It can also be mild, without
symptoms. When present, the symptoms are non-specific and usually include
, tiredness, loss of appetite,
, abdominal discomfort, dark urine, clay-colored bowel movements, and
(yellowing of the skin and eyes).
Parents should call the doctor immediately if any of the following occurs:
A blood test is required to diagnose hepatitis B. The test detects one of
the viral antigens called hepatitis B surface antigen (HBsAg) in the
blood. Later on, HBsAg may no longer be present, in which case a test for
antibodies to a different antigen, called hepatitis B core antigen, is
used. If HBsAg can be detected in the blood for longer than six months,
chronic hepatitis B is diagnosed.
There is no cure for hepatitis B and no specific treatment is available.
However, the following guidelines are often recommended:
Parents should ensure that their infected child has a well-balanced diet.
Children with advanced liver disease need to follow specific diets issued
by the treating physician. However, most children are not in this
category, and no special diet is recommended for them, except that they
should avoid eating fatty foods because the body has difficulty digesting
fat when the liver is not working well.
However, adequate protein intake is important to regenerate liver cells.
Children without liver cirrhosis require about 1–2 grams of protein
per pound (2–3 grams per kilogram) of body weight. Children with
cirrhosis need an individual
plan from their pediatric specialist or nutritionist.
There is some evidence that iron can lower the response to interferon
treatment in adults. Although no results have been reported for children,
the issue of restricting iron intake should be discussed with the treating
Viral hepatitis symptoms usually last three weeks to two months but may
last up to six months. Children may return to daycare one week after
symptoms first appear, with the doctor's permission. Most children
with hepatitis get better naturally without liver problems later on in
life. However, some children do have subsequent liver
problems. Thus, it is important to keep in close touch with the treating
physician and to keep all follow-up appointments. Chronic, or relapsing,
infection occurs with hepatitis B in about 5–10 percent of cases.
A vaccine for hepatitis B is as of 2004 widely used in the United States
for routine childhood immunization. Children usually receive the first
vaccine between birth and two months of age, the second vaccine at one to
four months, and the third vaccine at six to 18 months. The vaccine is
generally required for all children born on or after January 1, 1992,
before they enter school. The vaccine is available for older children who
may have not been immunized before 1992 and is recommended before age 11
—A chronic degenerative disease of the liver, in which normal
cells are replaced by fibrous tissue and normal liver function is
disrupted. The most common symptoms are mild jaundice, fluid collection
in the tissues, mental confusion, and vomiting of blood. Cirrhosis is
associated with portal hypertension and is a major risk factor for the
later development of liver cancer. If left untreated, cirrhosis leads to
Hepatitis B virus (HBV)
—Also called Hepadna virus, the pathogen responsible for
hepatitis B infection.
—A condition in which the skin and whites of the eyes take on a
yellowish color due to an increase of bilirubin (a compound produced by
the liver) in the blood. Also called icterus.
—A substance prepared from a weakened or killed microorganism
which, when injected, helps the body to form antibodies that will
prevent infection by the natural microorganism.
Hepatitis B vaccine
Jackson: University of Mississippi Press, 2002.
Berkman, Alan, and N. Bakalar.
Hepatitis A to G: The Facts You Need to Know about All the Forms of This
Clayton, Australia: Warner Books, 2000.
Blumberg, Baruch S.
Hepatitis B: The Hunt for a Killer Virus
. Princeton, NJ: Princeton University Press, 2002.
Everson, Gregory T., et al.
Living with Hepatitis B: A Survivor's Guide.
Long Island City, NY: Hatherleigh Press, 2004.
Green, William F., and H. Conjeevaram.
The First Year—Hepatitis B: An Essential Guide for the Newly
New York: Marlowe & Co., 2002.
Arya, G., and W. F. Balistreri. "Pediatric liver disease in the
United States: Epidemiology and impact."
Journal of Gastroenterology & Hepatology
17, no. 5 (May 2002): 521–25.
Helvaci, M., et al. "Efficacy of hepatitis B vaccination and
interferon-[alpha]-2b combination therapy versus interferon-[alpha]-2b
monotherapy in children with chronic hepatitis B."
Journal of Gastroenterology & Hepatology
19, no. 7 (July 2004): 785–91.
Liberek, A., et al. "Tolerance of interferon-alpha therapy in
children with chronic hepatitis B."
Journal of Paediatrics & Child Health
63, no. 23 (2003): 2625–49.
Murdoch, David L. et al. "Combined Hepatitis A and B Vaccines: A
Review of Their Immunogenicity and Tolerability."
40, no. 5–6 (May-June 2004): 265–69.
Shulman, Stanford T. "The History of Pediatric Infectious
55, no. 1 (January 2004): 163–176.
Sokal, Etienne. "Drug Treatment of Pediatric Chronic Hepatitis
4, no. 6 (2002): 361–69.
American Liver Foundation (ALF).
75 Maiden Lane, Suite 603, New York, NY 10038–4810. Web site:
Hepatitis B Foundation.
700 East Butler Avenue, Doylestown, PA 18901–2697. Web site:
Hepatitis Foundation International (HFI).
504 Blick Drive, Silver Spring, MD 20904–2901. Web site:
National Center for Infectious Diseases (NCID).
Centers for Disease Control and Prevention, Mailstop C-14, 1600 Clifton
Road, Atlanta, GA 30333. Web site: http://www.cdc.gov/ncidod.
"Viral Hepatitis B Homepage."
Available online at
(accessed October 22, 2004).
"What I need to know about Hepatitis B Homepage."
. Available online at
(accessed October 22, 2004).