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Hepatitis B

Hepatitis B - C

 

Hepatitis B is a viral infection which affects the liver. If the person contracts the infection, it usually resolves within a few weeks and there are no further medical problems. If the person becomes a carrier of the virus, the liver can be chronically inflamed. Cirrhosis and possibly cancer of the liver can develop years into the future. Natural history studies of chronic HBV among children are just beginning to appear in the medical literature. The risk of developing chronic HBV is correlated highly with the age of initial infection. Approximately 90 per cent of those infected prior to 1 year of age develop chronic HBV infection, whereas the rate decreases to approximately 40 per cent between 1 and 10 years of age and is less than 10 per cent among adults.

Hepatitis B can be transmitted from a mother to the newborn infant at the time of birth if the mother is infected and carries the Hepatitis B virus. In China, Hepatitis B is quite prevalent and 5 to 15 per cent of all those individuals infected with Hepatitis B can potentially become carriers of the virus lifelong. Children born to mother's who are carriers are then exposed to the virus at the end of the pregnancy and at the time of delivery. Because mother's frequently do not have prenatal care their carriage status is unknown and when the baby is delivered, the baby is not given Hepatitis B immune globulin and vaccine in an effort to prevent the infection in the newborn. This is standard procedure in the United States. Many orphanages now administer Hepatitis B vaccine, but this vaccine is given much too late to prevent infection from mother to infant at the time of birth. The vaccine will however at least decrease the transmission of the virus in the orphanage.

When little girls are in an orphanage, they are assessed for Hepatitis B virus with a blood test during the first few months that they arrive in the orphanage. On the medical exam, you may see the phrase "Hepatitis B surface antigen". Usually, you will see the word "negative" or a symbol "-" to indicate that the baby is not infected with Hepatitis B virus. Because the incubation period of Hepatitis B may be as long as six months, these results may not accurately reflect the Hepatitis B surface antigen status of your adopted daughter. Children can also be exposed to Hepatitis B virus in the orphanage by exposure to blood from staff members or other children who may be carriers of the virus. This is a blood borne infection and is transmitted in household settings by exposure to blood of the individual who is carrying the virus. An orphanage is equivalent to a household. This virus is not transmitted casually by sharing food or utensils from time to time. I recommend Hepatitis B vaccination for all household members when a family member is a Hepatitis B carrier. If your family consists of other children, they have probably been immunized as infants because Hepatitis B vaccine is required for school entry. Parents traveling to adopt a child abroad should be vaccinated before traveling. The vaccine is a three vaccine series which can be completed within six months. If you have two vaccines before you travel, this will probably afford some protection.

When the child arrives from China, we recommend testing for Hepatitis B which includes Hepatitis B surface antibody, Hepatitis B core antibody, and Hepatitis B surface antigen. If the antigen is positive, then we recommend further evaluation which may include Hepatitis B e antigen and e antibody.

I have evaluated over one hundred adopted Chinese girls over the past few years; the prevalence of Hepatitis B carriage is about 5-7%. All of the children are healthy and most have not required any treatment at this time. A few children have had elevated liver enzymes indicating some inflammation of the liver which has necessitated treatment with interferon. Interferon is a medicine which is injected three times a week for four months. One of the girls is completely free of the virus after treatment! There are many new treatments being studied currently and lots of intensive research is being devoted to the treatment of children and adults with chronic Hepatitis B infection. The future looks good for anyone with chronic Hepatitis B infection.

Another form of hepatitis is Hepatitis C. This is a blood borne infection as well. It is usually transmitted via blood transfusions, but it can be transmitted by exposure to blood. There is also transmission from mother to infant and sexually. There was a cluster of Hepatitis C infected children adopted in 1995 from Yangzhou, China, but , I, personally, have not cared for any children adopted from China with Hepatitis C infection in the past five years. We do recommend testing for Hepatitis C as part of the initial adoption screening.

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