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Infectious hepatitis is a syndrome characterized by injury (inflammation or death) to hepatocytes. The process may be self-limiting or may lead to fibrosis, cirrhosis, and neoplastic changes. Clinically, the hepatocellular insult is manifested by elevation of serum aminotransferases (alanine aminotransferase (ALT) and aspartate transaminase (AST)). Typically, the alphabetically designated hepatitis viruses (A–G) and, in particular, hepatitis viruses A, B, and C are those generally considered by the clinician when evaluating a child with hepatitis (Table 24–1). However, many other viral agents such as Epstein–Barr virus (EBV), cytomegalovirus (CMV), coxsackieviruses, echoviruses, West Nile virus, etc., have the potential to infect the liver and cause clinical or subclinical hepatitis (Table 24–1). This chapter will focus on the hepatitis A, B, and C viruses, the major causes of viral hepatitis in children.

Table 24–1. Viruses Associated with Hepatitis

Hepatitis A Virus

Hepatitis A virus (HAV) is a small nonenveloped RNA virus in the genus Hepatovirus within the Picornaviridae family.1 Transmission of HAV occurs predominantly via a fecal–oral route. Because the majority of HAV infections in children result in subclinical disease, children play a major role in the transmission of the virus within communities. Outbreaks of hepatitis A occurring in child care centers are well known to occur. Common-source outbreaks through the ingestion of contaminated food or water have also been well documented. Transmission of HAV via transfusion of blood or blood products occurs occasionally when donors are sampled during the viremic phase of the infection. High-risk groups for the acquisition of HAV infection include travelers to developing countries, men who have sex with men, users of injection and noninjection drugs, and individuals working with nonhuman primates.

With the advent of recommendations for vaccination of high-risk individuals and children residing in states with a high prevalence of HAV infection, followed by the more recent recommendation of routine vaccination of all children 1 year of age, the incidence of hepatitis A infections in the United States has decreased significantly.2 In 2007, the reported incidence of hepatitis A infection was 1 case per 100,000 persons in the United States. During that year, the lowest rates of infection occurred among children <5 years of age. Taking into account asymptomatic infections and underreporting, it was estimated that 25,000 new cases of hepatitis A occurred that year.3 This represented the lowest incidence ever recorded.

Hepatitis B Virus


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