Hepatitis E in Children

What is Hepatitis E in Children?

Hepatitis E is a disease that is widespread in many developing countries with a hot climate.

The infected person carries a typical or atypical form of the disease. The transmission mechanism is fecal-oral. This means that the virus is contained in the feces of a sick person, then through food and water it enters the body of a healthy person, causing infection. Also, hepatitis E in children is transmitted through household contact.

In a certain period of the year, the incidence of the population increases. This is called the seasonality of the infection / disease. The rise in the incidence of hepatitis E in Asia’s fear is associated with floods and showers, since these factors contribute to water pollution by sewage – this is how the virus enters the bodies of children and adults. That is, the highest incidence of hepatitis E occurs in autumn and winter.

Most cases of the disease were recorded among people aged 15-30, children make up about 30% in this list. It is suggested that children suffer from erased and subclinical forms of the disease, because such cases are not diagnosed and do not fall into the general statistics. That is, probably, the percentage of sick children exceeds 30%.

Until now, susceptibility to hepatitis E has not been precisely established, but it is considered to be high. Hepatitis E is not ubiquitous in Russia, Ukraine and other CIS countries. The reason is that the infection spreads mainly through water. Some experts attribute hepatitis E to natural focal diseases.

Causes of Hepatitis E in Children

The disease is caused by a virus-like particle having a spherical shape with a diameter of 27 nm. It does not have antigenicity with HAV (hepatitis A virus) and is not considered to be its variant or subtype.

The virus can be detected in the feces of people with manifestations of acute hepatitis, which is classified as hepatitis “neither A nor B”. Also, these virus-like particles were found in the feces of monkeys, over which an experiment was carried out to infect hepatitis E. Viral particles react with the sera of the same patients and experimental animals in the stage of convalescence.

Pathogenesis during Hepatitis E in Children

Why hepatitis E affects the liver, what processes it causes there, has not been established by medicine. It is assumed that the mechanisms are similar to those in hepatitis A. When an experiment was conducted on monkeys, by the end of the month from the moment of their infection with a suspension of fecal extract from patients with hepatitis E in animals, a picture of acute hepatitis was found in the liver, which was accompanied by an increase in the level of transaminases. In feces, virus-like particles appear simultaneously. On day 8-15, antibodies to the virus are found in blood serum.

The morphological picture of the liver with hepatitis E is generally similar to hepatitis A.

Symptoms of Hepatitis E in Children

The incubation period is quite diverse, it can take from 10 to 50 days. First of all, the patient develops lethargy, weakness in the body, and appetite decreases. There may be nausea and bouts of vomiting, a child may complain of abdominal pain. Rarely there is an increase in temperature, which distinguishes hepatitis E from hepatitis A.

From 1 to 10 days, the pre-icteric period lasts. Typically, a darkening of the urine 3-4 days after the onset of the disease. Symptoms increase gradually, jaundice manifests itself in 2-3 days. In this case, the symptoms of intoxication do not disappear, which, again, distinguishes this type of hepatitis. Patients even during jaundice complain of weakness in the body, loss of appetite. The pain occurs in the area under the xiphoid process (epigastric) and in the right hypochondrium. Symptoms of hepatitis E may occur such as itchy skin and slightly elevated (low-grade) body temperature. In all sick children, an enlarged liver is observed. The edge of the spleen can be palpated in very rare cases.

The content of total bilirubin is increased in blood serum by 2-10 times at the height of the disease, mainly due to the direct fraction. The activity of hepatocellular enzymes is increased 5-10 times. The thymol test remains normal, in some cases it can be increased by no more than 2 times (which is similar to hepatitis B).

From 2 to 3 weeks, the icteric period lasts with hepatitis E in children. The size of the liver is gradually returning to normal, as is the activity of enzymes.

The disease has an acute course. The structure and functions of the liver are fully restored only after 2-3 months. The clinical course is similar to that of hepatitis A. Children do not have a fatal outcome. Chronic hepatitis E is also not described in the medical literature.

Diagnosis of Hepatitis E in Children

This disease is diagnosed by ELISA – antibodies to hepatitis E virus (IgM class) are detected in the blood serum. Or virus RNA is detected in PCR.

Hepatitis E Treatment in Children

With hepatitis E, treatment is similar to that for other viral hepatitis.

Topical in the treatment of hepatitis E is symptomatic therapy aimed at reducing intoxication and pain. Hepatoprotectors are also prescribed to maintain and enhance liver function. A sparing diet for hepatitis E is mandatory as well as for other types of virus.

Prevention of Hepatitis E in Children

An emergency notification to the SES (sanitary-epidemiological service) must be sent when cases of hepatitis E are recorded. After isolation of a sick child in kindergartens and schools, a final disinfection is carried out, quarantine is announced in groups for a period of 45 days.

Children in contact with a sick child are regularly observed by a doctor until the quarantine expires. Those who have not previously had hepatitis E can receive immunoglobulin. But the effectiveness of immunoglobulin in these cases is not fully proven. It is believed that the method is effective only if the commercial immunoglobulin series contain antibodies to the hepatitis E virus.