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Prevention of Hepatitis B Prevention of hepatitis B disease, in the form of a vaccine, has been available for two decades now.  The use of the vaccine in national immunisation programs has reduced the carrier pool in many countries.  Another substance now available is the Hepatitis B immunoglobulin (HBIG).  This is a product of the human body that destroys the virus, and is produced from the blood of people with immunity to hepatitis B. These two measures can be used to give specific protection to infants born to women who are carriers.  These women should be identified through screening of all pregnant women.  The hepatitis B vaccine and Hepatitis B immunoglobulin should be kept in readiness at time of delivery, and administered to the baby as soon after birth as possible. The vaccine has been in use for twenty years now, and has been found to be safe and effective.  It should be given to all children, and can also be taken by adults.  Children who require frequent blood transfusions or blood products must also be given this vaccine.  It is recommended for adults whose work puts them at risk -- hospital and laboratory employees, doctors, etc.   An important point is that this vaccine must never be given into the buttock or hip -- doing so reduces its efficacy.  It has to be given into the thigh in children, and into the shoulder in adolescents and adults. The vaccine is given in three doses -- once as soon as birth as possible, the second dose after a month, and the third dose five months after the second.

Hepatitis B Disease
in Children

300 million people around the world are infected with the Hepatitis B virus, and 1-2 million die of it every year.  Most of these people acquired the infection at birth or as young children.  The hepatitis B virus is the second most common cause of cancer in humans, after tobacco smoke.  Apart from liver cancer, hepatitis B also gives rise to acute hepatitis, which can cause death when severe, and chronic hepatitis and cirrhosis of the liver, which also cause death over several years.

The Hepatitis B Virus

The Hepatitis B virus has an affinity for the liver, and enters the liver cells (called hepatocytes) when in the body.  Reproduction of the virus causes death of these cells.  The sudden death of a large number of liver cells can cause failure of the liver, and the child has deep jaundice, bleeding, and seizures, becomes unconscious, and may sometimes die.

In most children, however, this acute picture is not seen.  The virus multiplies slowly and persists in the body, causing slow liver damage.  This state is known as the chronic carrier state, in which the person has the virus in the liver and blood, but no signs of disease.  These people are infectious to others.

Most children who acquire the infection at birth or soon after become chronic carriers.  In contrast, adults who get the infection have an acute illness, followed by clearance of the virus.  Thus protection of children by vaccination is important.

How Is It Spread?

The most important route in childhood is transplacental -- infection transmitted to the baby across the placenta by a mother who is a chronic carrier.  Almost all children infected in this way will become chronic carriers themselves.  Also called vertical transmission, this route can now be interrupted by preventive measures.  

Another important route is via blood and blood products.  Blood products are clotting factors for children with hemophilia, immunoglobulins for children with immunodeficiency disorders, etc.  Children with diseases like  thalassemia and hemophilia are thus at high risk for hepatitis B.  Blood borne infection is now rare, owing to judicious use of blood transfusions, and testing of donors and blood.

Rare routes of Hepatitis B infection in childhood are injections with unclean syringes, organ transplantation, and sexual abuse.  

Long Term Hepatitis B Infection

As the virus multiplies, the liver cells are destroyed, causing loss of liver function.  This leads to jaundice, bleeding, fluid accumulation, etc.  This is known as chronic hepatitis.

Long term Hepatitis B infection can also be accompanied by liver cirrhosis.  The liver is shrunken, and poorly functional.  Liver cell cancer is another life threatening complication of long term hepatitis B virus infection.  

Treatment

The aim of treatment is to stop multiplication of the virus, and if possible, eliminate it from the body.  This is necessary to prevent progression from the chronic carrier state to chronic hepatitis, liver cirrhosis, and liver cancer.

Two treatment modalities are available -- interferon and anti viral drugs.  Interferon is a product of the body's immune system that destroys viruses.  It has now been synthesized in the laboratory, and has been used for the treatment of chronic hepatitis.  Treatment with interferon is prolonged and expensive.

Among the antiviral drugs, lamivudine has given fairly good results.  Another drug being tried is Adefovir.  These drugs have also been used in combination with each other, and with interferon.  If these measures fail, or if cancer develops, one option is liver transplantation.

None of these drugs or combinations are reliably effective, yielding cure rates of around 40%.  The only good strategy against hepatitis B is to prevent it.

Last revision: July 15, 2007

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