Thanks to widespread (and now universal) childhood vaccination, the number of new cases of hepatitis B in the United States has dropped dramatically in the last two decades. However, there are still about 1.2 million people in the U.S. with the infection. Most new cases in the U.S. now are in people who have immigrated or children adopted from countries in the Far East, Western Africa, or Eastern Europe, where hepatitis B is still widespread.
And because a person can have hepatitis B for years, even decades, with few or no symptoms, many people with the hepatitis B virus (HBV) do not even realize it. For this reason, it is not uncommon for multiple members of a family to be infected with HBV.
There are two phases of hepatitis B. Symptoms during the acute phase – which encompasses the first six months after a person is infected with HBV – can vary depending on the age of the patient. Infants infected from their mothers at birth often show no symptoms at all and young children may have only non-specific symptoms. Teenagers and adults can become quite ill with jaundice, loss of appetite, abdominal pain, fatigue and other symptoms.
Chronic hepatitis B – defined as an HBV infection lasting more than six months – is a serious, long-term infection that can, over the course of decades, damage the liver to the point of cirrhosis, or even cause liver cancer. The risk that a child's infection will progress to the chronic phase depends on how young he or she was infected with HBV: The younger their age at infection, the more likely that the infection will become chronic.
While acute hepatitis B is treated with rest, fluids, and a healthy diet, treating chronic hepatitis B is more complicated. The decision to treat depends largely on whether the virus is actively causing liver damage, which can take years to arise. For that reason, children and adults with chronic hepatitis B are closely monitored for any signs of harm to the liver.
How Boston Children's Hospital approaches hepatitis B
The Center for Childhood Liver Disease at Boston Children's Hospital is one of the leading centers internationally for the care of children with hepatitis B. Because hepatitis B in children often becomes a chronic condition, it requires a long-term approach to treatment and care. Our board-certified pediatric hepatologists understand the nuances of caring for a child with hepatitis B, including when to carefully watch a child’s progress and when to take a more aggressive stance. We work with families and pediatricians to make sure that children with hepatitis B – and their families – receive the long-term care and monitoring they need.