Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). This virus is completely different from hepatitis A. Only about 10 percent of children who become infected with HBV show any symptoms. When children do have symptoms, they may be similar to those for hepatitis A: fatigue, loss of appetite, jaundice, dark urine, light stools, nausea, vomiting, and abdominal pain. However, hepatitis B is a much more serious infection. After infection with HBV, chronic infection develops in 70% to 90% of infants, 15% to 25% of 1- to 4-year-old children, and 5% to 10% of older children and adults. Premature death from cirrhosis or liver cancer occurs in 15% to 25% of persons with chronic infection. Persons who develop chronic HBV infection may remain infectious for the rest of their lives.

HBV infection is most commonly spread:

By infected mothers to newborn infants through blood exposure at birth.
By sharing contaminated needles during intravenous drug abuse.
Through sexual intercourse.
Through exposure of cuts or mucous membranes to contaminated blood.
HBV infection can also be transmitted if infected blood or body fluids come in contact with nonintact skin of an uninfected person, such as by biting, if the skin is broken. However, this is rare.

Hepatitis B is vaccine-preventable. All infants should be vaccinated with three doses of hepatitis B vaccine during the first 18 months of life. A child not previously vaccinated should receive three doses of vaccine by the age of 11 or 12 years. Child care providers should discuss with their doctor whether it is appropriate for them to receive hepatitis B vaccine.

To reduce the spread of hepatitis B:

Require parents to submit up-to-date immunization certificates when previous certificates expire.
Make sure that all children and adults use good hand washing practices.
Do not allow children to share toothbrushes.
Clean up blood spills immediately.
Wear gloves when cleaning up blood spills unless the spill is so small it can be contained in the cloth or towel being used to clean it up.
Wear gloves when changing a diaper soiled with bloody stools.
Disinfect any surfaces on which blood has been spilled, using freshly prepared bleach solution.
If a child care provider has open sores, cuts, or other abrasions on the hands, the provider should wear gloves when changing diapers or cleaning up blood spills.
Observe children for aggressive behavior, such as biting. A child who is a chronic HBV carrier should be evaluated by a team that includes the child's parents or guardians, the child's physician, public health personnel, the proposed child care provider, and others to determine the most appropriate child care setting. This evaluation should consider the behavior, neurologic development, and physical condition of the child and the expected type of interaction with others in the child care setting. In each case, risks and benefits to both the infected child and to others in the child care setting should be weighed.

© January 1997