What You Need to Know About Hepatitis B
Q: If I receive a referral that says the child is infected with hepatitis B, what do I need to know?
A: Hepatitis B is a contagious virus that can be passed from a mother to a baby at or around the time of birth. It can also be passed from one child to another in an orphanage, through blood or body fluids. Hepatitis B is the most common serious disease seen in internationally adopted children—about 5 percent come here with an active infection, even more from Asia (with the exception of South Korea, due to better screening there) and Eastern Europe, including Russia. But the good news is that, with appropriate screening throughout their lives, most people who are diagnosed as hepatitis B carriers have little to no ill effect from the disease and go on to lead normal lives.
What’s the difference between being a carrier of hepatitis B and having the disease?A carrier of hepatitis B is anyone who has been infected with the virus. Sometimes the infection becomes chronic hepatitis B disease, and sometimes a child will spontaneously clear the virus and will not be contagious. More than 90 percent of infants infected by their birthmother will contract the disease; 25 to 50 percent of children infected between ages 1 and 5 will, and 6 to 10 percent of older children and adults will. But most who have the disease do not suffer extreme symptoms-—and many have no symptoms at all.
What additional testing is needed?A report of hepatitis B in an international referral may or may not be accurate, due to wrongly interpreted test results or faulty testing to begin with. So all children adopted internationally should have a complete hepatitis B screen (HBsAg, HBsAb, HBcAb) soon after adoption (not before, in their birth country), with precautionary follow-up testing done six months later. For children adopted domestically, a physician should review birth records to see if the biological mother was tested. If this cannot be determined, the child should be tested.
What are the medical problems my child might face?Symptoms of the illness include jaundice, fever, liver enlargement, abdominal pain, nausea, diarrhea, and fatigue, sometimes leading to liver failure, liver cancer, or cirrhosis in adulthood. But many babies and young children who contract the disease never experience adverse effects at all, because their immature immune systems do not perceive the virus as abnormal and therefore do not react to it (or react only slightly) negatively.
There are no proven treatments for hepatitis B, but research on lessening the long-term risks is underway. Children who have long-term hepatitis B but who show no ill effects should be examined and screened once a year by a specialist in pediatric infectious diseases or liver diseases. For the few who experience symptoms of the disease, have highly elevated liver enzyme levels, or who are not developing normally, additional follow-up will be needed to monitor long-term side effects.
Is a child with hepatitis B contagious?Though it rarely happens, hepatitis B may be passed through saliva, as well as via washcloths, towels, razors, and toothbrushes. Fortunately, the virus is not transmitted casually, through the sharing of toys, sneezing, coughing, via hugs, or through the sharing of food or eating implements. So children who carry the virus usually won’t pass it to other children at play or at school.
A child with hepatitis B virus can pass it to other members of the household, but the risk significantly decreases for those who are vaccinated. As a precaution, families beginning the international adoption process should immediately start the three-dose series of the hepatitis B vaccine, even if they will not be traveling for the adoption. Family members of a child adopted from foster care or whose hepatitis B status is not known at the time of adoption should also be immunized.
If my child has hepatitis B, do I have to tell her day-care provider or school?Opinions vary as to whether schools and child-care centers should be notified when a child carries hepatitis B. Under the Americans with Disabilities Act, it is illegal to discriminate against an individual with an infectious disease. Remember that information about a child having hepatitis B is private, but once shared with others, it cannot be taken back—and may be misinterpreted, particularly by those not familiar with this disease.
What should I be concerned about long-term?When a person with chronic hepatitis B is teenage and beyond, she should be evaluated by a gastroenterologist and an infectious-disease specialist twice a year to monitor liver health and function and to screen for cancer. When complications are caught early, they can be treated more effectively. In addition, people with hepatitis B complications can help themselves by avoiding alcohol and certain medications that may exacerbate their condition.
A referral that indicates hepatitis B needn’t dominate your decision to adopt. Remember that some referrals are inaccurate, most hepatitis B carriers lead normal lives, and most long-term symptoms of the disease can be managed with proper medical attention.
DEBORAH BORCHERS, M.D., is a founding member of the American Academy of Pediatrics Section on Adoption and Foster Care, and the mother of three children adopted internationally.
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