#HEALTH: Managing hepatitis in children

HEPATITIS is an inflammation of the liver that can be caused by a variety of reasons, including infectious viruses and non-infectious agents.

Most cases of acute hepatitis will resolve over time with treatment. Occasionally, some patients may progress to acute liver failure, which can be fatal.

There are five main strains of hepatitis viruses: A, B, C, D, and E. These viruses can all cause hepatitis, but they are different in the way they are transmitted. Sunway Medical Centre paediatric gastroenterology and hepatology consultant Dr Ong Sik Yong says children are not spared from contracting these viruses.

"Usually, treatments in children will focus on supporting their general condition or reversing existing damage if possible."

Dr Ong says hepatitis A does not cause chronic liver disease. On the other hand, he adds, hepatitis B and C can cause chronic infection, and infected patients are at risk of death from liver cirrhosis and liver cancer.

Children with acute or chronic liver disease will require appropriate medical examinations to identify the cause before specific treatment can be provided. Dr Ong says there are certain liver diseases, such as autoimmune hepatitis, where certain medications may be used to regulate the overactive immune system that will prevent further attacks on the liver.

In chronic hepatitis, which can arise from viral hepatitis infections such as hepatitis B or C, fatty liver disease, drugs or autoimmune diseases, patients are often asymptomatic, thus the disease is only discovered in advanced stages and sometimes incidentally through physical examinations or blood tests for other illnesses.


There are many ways that viral hepatitis can be transmitted.

For example, hepatitis A and E are typically transmitted by the faecal-oral route, where a child may get infected after consuming contaminated food or water.

Hepatitis B, C and D, however, are transmitted via the parenteral route — a result of parenteral contact with infected body fluids.

In Malaysia, the hepatitis B vaccination programme for children that was introduced in 1989 has reduced the prevalence among Malaysians to 0.01 per cent.

All newborn babies receive their first hepatitis B vaccination after birth, preferably within 24 hours of birth, and two subsequent boosters by six months.

For pregnant women who are hepatitis B carriers, an antenatal antiviral prophylaxis is recommended to prevent mother-to-child transmission.

"Hepatitis B vaccination and hepatitis B immunoglobulin given to newborn babies born to hepatitis B carrier mothers help reduce the risk of viral transmission significantly," says Dr Ong.

The hepatitis A vaccine is usually given from age 1 onwards with the second dose at least six months after the first dose. There are no vaccines against Hepatitis C, D and E.


IN acute hepatitis, the child may experience the following symptoms:

Jaundice (yellowing of the skin and eyes)

Dark urine

Extreme fatigue



Abdominal pain

Other symptoms are fever and/or loss of appetite.

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