Hepatitis means inflammation of the liver. Hepatitis B is a virus that causes an infection. It is present in blood and bodily fluids. The body’s immune system responds to the virus and this response can damaged the liver.
There are two different ways hepatitis B can cause illness: acute hepatitis B and chronic hepatitis B.
Acute hepatitis B can occur in both adults and children, although it is less common in children. Sometimes there may be no symptoms but in other cases it can cause you to become very ill.
Chronic hepatitis B occurs when acute hepatitis B does not clear from the body. When the virus stays in the body for more than six months this is called chronic hepatitis B. This is more common in children but can occur in adults as well.
Those who acquire hepatitis B as children are much more likely to develop a chronic (long-term) infection. Chronic hepatitis B develops in around:
- 90 out of 100 babies with hepatitis B
- 20 out of 100 older children with hepatitis B
- 5 out of 100 adults with hepatitis B
Symptoms of hepatitis B
Most children have a mild disease, with no symptoms. They grow normally and are able to live a completely normal life. It tends to be in later years that the virus can cause problems. Symptoms are more likely in acute rather than chronic infection.
Symptoms of acute hepatitis B include:
- General aches and pains
- A high temperature (fever) of 38C (100.4F) or above
- A general sense of feeling unwell
- Loss of appetite
- Feeling and being sick
- Tummy pain
- Yellowing of the skin and eyes (jaundice)
- Dark urine and pale poo
Acute hepatitis can, in some rare cases, lead to acute liver failure. This is when the liver is badly damaged over a short period of time and stops working properly. In these cases a liver transplant may be needed. This complication is very rare and only happens in around 1% of hepatitis B infections.
Symptoms of chronic hepatitis B:
Most children with chronic hepatitis B have no symptoms. However, some children may experience symptoms. These may be the same as those for acute hepatitis B but they are less mild and tend to come and go.
It is important that children are referred to a specialist children’s liver centre where their liver function and hepatitis B virus can be monitored, assessed and potentially treated.
Prevention of hepatitis B
From 1st August 2017 all babies born in the UK are offered the hepatitis B vaccine as part of the universal vaccination which is given at eight, 12 and 16 weeks of age.
Vaccination and treatment of newborns at risk of hepatitis B
There are different products which are available to try and stop hepatitis B developing in babies born to mothers with hepatitis B. These differ from the routine vaccinations which are given to all babies when they are born. Babies who are born to mothers with hepatitis B have an accelerated course which involves doses of the vaccination at birth, four weeks, eight weeks and a booster at one year.
Sometimes the blood test can show that a mother is particularly infectious. If this is the case the child may be given another injection of specific hepatitis B immunoglobulin (HBIG) at birth, as well as the vaccine, to help them to fight the infection. This provides temporary immunity whilst waiting for the vaccine to work.
Babies who are born to mothers with hepatitis B should receive the first vaccine as soon as possible after birth, definitely within the first 24 hours of life. HBIG should be given at the same time as the vaccine or as close as possible to the vaccine within 24 hours of it.
Vaccination timings for a child at risk of hepatitis B:
- At birth – within 24 hours of birth
- 1 month
- 2 months
- 12 months
- A booster dose at 3 years old with their pre-school vaccinations
Children require all of these vaccinations in order to be protected.
Babies born to a mother with hepatitis B should have a blood test at 12 months old to find out if the vaccine has worked and the child has developed immunity against the virus. This can be done at your GP surgery, local community clinic and, in some cases, at home.
Vaccination is 90-95% effective in protecting babies from long-term hepatitis B infection.
Breastfeeding is not thought to have an effect on passing hepatitis B onto a child and it is recommended that mothers can breast feed their children once the infant is being vaccinated as long as they don’t have bleeding, cracked nipples.
Other individuals who should consider vaccination:
- The families/siblings of those with chronic hepatitis B
- Sexual partners of individuals with hepatitis B
How can I prevent my child passing the infection to other people?
Ensure your child know what they need to avoid e.g. not to share toothbrushes with friends and how to clean up any blood spills they may have.
How did my child get hepatitis B?
Hepatitis B is spread when blood from an infected person enters another person’s body. The virus can be spread even if the person doesn’t have any symptoms. It cannot be spread by casual contact such as sharing utensils, cups, kissing, cuddling, hand holding or by breast feeding.
The main way children in the UK contract hepatitis B is at birth from mothers who have hepatitis B.
Mother to child (vertical transmission)
Pregnant women in the UK are tested for hepatitis B as part of their routine during pregnancy. If a pregnant woman tests positive for hepatitis B and she has been told that she is a high risk carrier of the infection, she should receive oral antiviral treatment in the third trimester of the pregnancy.
This will help to reduce the risk of her child also contracting the infection. Babies born to mothers who have hepatitis B are considered high risk infants. These babies should receive the accelerated hepatitis B vaccination course.
Hepatitis B is highly infectious and can also be spread via the following routes:
Community (horizontal) transmission
Hepatitis B can be spread when blood from an infected person enters another person’s body. Ways this can happen include:
- Contact with open wounds or a bite that breaks the skin
- Sharing toothbrushes and razors, shavers and equipment for cutting hair
- Receiving contaminated blood during a medical procedure. Blood donations in the UK are screened for hepatitis B to remove the risk but it is possible to receive contaminated blood in other countries
- Using intravenous drugs and sharing drug taking equipment
- Sexual intercourse
You may not see any blood on an item but this doesn’t mean there isn’t any blood or virus present. The hepatitis B virus can last up to a week on dry surfaces.
What treatment is available?
At the moment, there is no cure for hepatitis B. Treatment is aimed at controlling the virus by reducing the amount of hepatitis B in the blood, reducing the risk of spreading the infection and preventing damage to the liver.
Fostering and adoption
Families adopting from any countries where hepatitis B is often found at intermediate or high levels are advised to have the hepatitis B vaccination. The vaccine will reduce their risk of contracting the virus. Adopted children from these areas should be tested for hepatitis B so the virus can be monitored and managed if it is present.
An infant born to a mother with hepatitis B won’t be able to be tested until they are 12 months old. If you adopt or foster a very young child whose mother has or may have hepatitis B you will need to make sure they receive their vaccinations at 1 month, 2 months and 12 months of age. They will also be offered a booster dose at 3 years old.
Foster carers, and their families, should also be immunised against hepatitis B if they are looking after children who are at high risk of having hepatitis B. When a child is fostered there should be a medical exam and a health assessment of the child during the process. Carers should be advised about any infection risks and whether they need to be immunised.
Guardians should check the child’s red book to see if the vaccination has been given and to check whether the child has been tested for the surface antigen, HB core antibody and HB surface antibody. From these it is possible to tell if the child has immunity or not.
Who should I tell about my child’s hepatitis B infection?
Choosing whether to tell people about your/your child’s hepatitis B status is a very personal decision and there is no right or wrong answer. There can be a stigma associated with hepatitis B and sometimes family and friends don’t fully understand what it is. Some people, however, find that support from family and friends is important and helps them to copy with the diagnosis better.
It is also up to parents when to tell children about their health. It is helpful that even young children receive some information about what they can do to prevent passing the infection on to others. This includes children not letting anyone touch their blood if they have a cut or a nose bleed and telling an adult when they are bleeding.
Whether or not to tell a child’s school is also a difficult decision for some parents. There is a worry that the school may stigmatise or treat a child with hepatitis B differently but they should ensure confidentiality at all times.
This website provides general information but does not replace medical advice. It is important to contact your/your child’s medical team if you have any worries or concerns