Information on Hepatitis

Type A, type B, type C .hepatitis is just too confusing! What do all those letters mean, anyway? As a childcare provider, what do you really need to know about these ABC's?

Hepatitis is a general medical term for an acute inflammation of the liver. The most common forms are caused by a virus. Let's take a closer look at two types of hepatitis that may have implications in the childcare setting: hepatitis A and hepatitis B.

Hepatitis A commonly is found in children and young adults. It characteristically appears abruptly as an acute, self-limiting illness with fever, fatigue, jaundice (yellowing of the skin or eyes), loss of appetite, dark urine, abdominal pain, nausea, and vomiting. Symptoms usually last less than two months, although a prolonged illness as long as six months occasionally can occur. Infants and preschool children may experience only mild, nonspecific symptoms without jaundice. Because of this fact, some individuals may be unaware that they have ever had hepatitis A. In contrast to most other infectious diseases common in childcare settings, the first indication of the disease may come when an adult exhibits symptoms. In children, the illness often is confused with "the flu."

The hepatitis A virus is spread from person to person through fecal matter. This means something contaminated with the virus reaches the mouth of another person. For this reason, hepatitis A virus easily can be spread in settings where sanitary conditions are poor or where good personal hygiene is not practiced. Food is often the source of outbreaks. One of the best ways to prevent the spread of hepatitis A in childcare is cheap and simple--good hand washing practices!

Hepatitis A is a reportable disease. This means that the medical provider who diagnoses the disease is required by law to report it to local health officials. The local health department should then work with the medical provider and others to try to manage the disease to limit its spread and treat those who are exposed to it. Children or adults who have had hepatitis should provide written medical clearance before returning to the childcare setting. Additionally, the local health department should make the decision as to how to treat individuals who may be exposed. Post-exposure treatment with medication may be recommended. Fortunately, long-term negative effects from hepatitis A are uncommon.

Hepatitis A vaccine is available and offers protection if administered prior to exposure. In the U.S., the vaccine is recommended for children in communities with high rates of hepatitis A, particularly common in some western states (see Hepatitis Facts). The vaccine also is recommended for those traveling to countries such as South America, Africa, Asia, and Europe. Routine vaccination in childcare settings is not suggested, and the vaccine cannot be given to children less than two years of age.

Hepatitis B illness has a wide array of symptoms, including many of those seen in hepatitis A. Symptoms may be mild, unrecognized, and nonspecific, such as loss of appetite, nausea, and fatigue, or the disease may be more readily identified by jaundiced eyes and skin, and include fever, joint pain, and rash. As with hepatitis A, young children may not have identifiable symptoms. A major concern of infection with the hepatitis B virus is the development of chronic liver disease.

Hepatitis B is a blood-borne pathogen, meaning it is most often transmitted through contact with blood or body fluids. Children who carry hepatitis B can be included in childcare activities unless they typically engage in behaviors that put other children at risk, such as biting or scratching, or have certain skin conditions or bleeding problems. Universal precautions, which include the simple measures of using gloves and washing hands according to guidelines established by the Federal Occupational Safety and Health Administration (OSHA), will help prevent the spread of hepatitis B.

There is no specific therapy for acute hepatitis B infection. However, hepatitis B is preventable! The hepatitis B vaccine is available for all age groups. Most states require that children be vaccinated against hepatitis B before enrolling in school. The Centers for Disease Control and Prevention (CDC) recommend that children be immunized against hepatitis B beginning at birth or age two months. A series of three shots provides complete protection. Additionally, many states now require hepatitis B vaccination for those children of middle school age who have not been immunized.

Workers whose job duties routinely expose them to human blood also should be immunized. Arrangements for receiving vaccinations at reduced cost are available, often through local health departments. All staff in childcare settings should be instructed in OSHA guidelines for blood-borne pathogens upon employment, and annual updates and reviews should be provided.

And what about the rest of the alphabet? Thankfully, the other types of hepatitis such as hepatitis C, Delta hepatitis, and non-A and non-B types are transmitted by blood transfusions, sexual contact and intravenous drug abuse, and they have not been identified as problems that are easily associated with childcare centers. Hepatitis C is the most frequent chronic blood borne infection in the U.S. although the number of new infections has significantly decreased since the 1980s. Most people infected with hepatitis C have a mild, chronic infection and may not know they are infected.

So for childcare providers, learning this alphabet is easy! With simple precautions, staff training, and proper attention to the health of the children in your care, you can lower the risk of hepatitis.

by Janie Sailors, RN, Health Specialist, Region IV Head Start Quality Improvement Centers, Western Kentucky University, Bowling Green, KY

CDC Hepatitis web pages for Hepatitis A and B, www.cdc.gov/ncidod/diseases/hepatitis/

Hepatitis Foundation International, 30 Sunrise Terrace, Cedar Grove, NJ 07709; 973-239-1035; www.hepfi.org.

Consult your local health dept. for more information.