Hepatitis A, B, C, D, E

NATURE OF ILLNESS

Each of these diseases is due to a distinct and separate virus. Hepatitis A and E are spread by the fecal-oral route, B, C and D are spread by contact with blood and other body fluids. When any one of the five viruses invades the body, they affect the liver and produce similar symptoms:

PHYSICAL FINDINGS

1. Fever, malaise, headache, fatigue.
2. Jaundice
3. Dark urine, light colored stools
4. Loss of appetite, nausea, stomachache, vomiting.
5. Most cases are mild
6. May have all symptoms except jaundice. These children usually remain undiagnosed but are just as contagious.

INDIVIDUAL DIFFERENCES

Incubation period: A=4-7 weeks; B=1-6 mos; C=7-9 wks; D=1-6 mos; E=15-60 days Period of infectivity: A=short; B=may be long; C=unknown; D=may be long; E=unknown May be a carrier: A=no; B=yes; C=yes; D=yes; E=probably no efficacy of immune globulin: A=excellent; B=good; C=questionable; D=good HBIG; E=ineffective

UNIQUE CHARACTERISTICS

HEP A: Usually mild in children, 85% cases have no jaundice. The period of greatest infectivity is 1-2 days before onset of jaundice. May return to school as soon as fever and jaundice are gone and appetite has returned. Some doctors recommend prolonged (4-6 wks) bed rest; this is rarely necessary.

Immune globulin is protective if given within 10-14 days of exposure. It is recommended for close contacts, e.g.: members of household; day care center for younger children not yet toilet trained; institutionalized children. Exposure at regular school is not considered a close contact and therefore IG is not recommended except under unusual circumstances. Active immunization is now available and effective.

HEP B: Transmitted in same manner as HIV: Drug users sharing needles, promiscuous sexual contact.
Carrier state may be accompanied by chronic liver infection leading to cirrhosis or cancer. Carriers are just as contagious as active cases.
Hepatitis B Immune Globulin (HBIG) now available and effective.
Active immunization available and effective. Most school personnel are not at high enough risk to warrant active immunization. School nurses who draw blood (e.g. for EPSDT exams) should be immunized. POST-EXPOSURE prophylaxis is effective because of long incubation period.

HEP C: Clinical course usually mild though may result in carrier state and/or chronic liver infection as in Hep B.
Often associated with blood transfusion.

HEP D: Only occurs in combination with Hep B. Causes patient with Hep B to be sicker and more likely to develop chronic liver disease.

HEP E: Same features as Hep A, except causes more severe disease. So far, not seen in Western Europe or U.S., but cases have occurred in travelers.
Usually causes more severe illness than Hep A.

MANAGEMENT:

1. Refer to physician.
2. Report to health department.
3. Follow school policy for parental notification.
4. Recommend proper type immune globulin only to close contacts, not classroom contacts:
Hep A: regular IG
Hep B: HBIG.