Hepatitis A infection in the orphan child

Is Hepatitis A infection something that I should worry about in my internationally adopted child?

Like the other forms of hepatitis B & C, hepatitis A is a viral infection affecting the liver, and it generally results in lifelong immunity to the virus. In many developing countries, most children are exposed to the hepatitis A virus early in life. In overt cases of hepatitis A infections, the condition is easily recognized by it signs and symptoms. In the pediatric population however, a good proportion of children can have the anicteric for (without yellowing of the skin) and can go unrecognized. The majority of children affected with the Hepatitis A virus will recover completely, and only a small proportion will go on to develop a more aggressive for of hepatitis.

In children that live in orphanages or day care like setting, the primary means of person-to-person transmission is via the fecal-oral-route. The second method of transmission is by the ingestion of contaminated food or water that has been contaminated with the Hepatitis A virus. The major reason why this is a communicable disease is that fact that the virus will shed in an infected child stool for 1 to 2 weeks before the child even presents with any signs or symptoms of disease. Once the signs and symptoms of Hepatitis A appear and an accurate diagnosis is made, the viral transmission through the stool decreases. In an orphanage or institution, hepatitis A infection can run rampant, infecting a majority of the cases in a short period of time. Since an majority of the children have asymptomatic disease, during the first two weeks if the illnesses, these children act as a vector to spread the virus to other children and to those who care for the children and change the diapers.

Signs and symptoms of Hepatitis A infection are pretty easy to recognize if they are there:
1) Gastrointestinal Upset (Poor appetite, vomiting, diarrhea)
2) Jaundice (yellow skin)
3) Pain in the region of the liver, right upper quadrant, right below the right rib cage.
4) Dark urine
5) Stool become light and clay colored
6) Knowledge of local epidemic in the orphanage.

An attempt to isolate the infected child during the initial phases is indicated in order to reduce the possibility of widespread orphanage epidemic. Unfortunately, by the time the child is diagnosed with the Hepatitis A virus, he may already be in the noninfectious phases. For the caregivers, it is imperative to handle diapers; stool and soiled clothing with care in order to not become infected also.
For those exposed and were in direct contact with an infected child immunization with Hepatitis A immunoglobulin can be administered if it is available.

Additional information and references:

1) Miller, L. (2004). The Handbook of International Adoption Medicine: A Guide for Physicians, Parents, and Providers. Oxford University Press, Cary, NC

2)William W. Hay M.D. Current Pediatric Diagnosis and Treatment. McGraw-Hill Medical Publishing.

Article Source: http://www.adoptiondoctors.com/articles

Written by George Rogu M.D., Medical Director and founder of Adoptiondoctors.com and Adoptioneducationclasses.com AdoptionDoctors.com, is an innovative adoption medicine educational service, dedicated to helping parents and adoption agencies with the complex adoption related medical issues encountered in the internationally adopted child. Pre-Adoption medical record evaluations and Blind Referral support services are also provided via this website. Post-Adoption Medical Care is provided in our Adoption Friendly General Pediatric Private practice, in Long Island New York. For more information, visit AdoptionDoctors.com or call 631-499-4114 or 631-666-1300 © George Rogu, M.D. Disclaimer: The information provided is intended for educational purposesonly. It is not intended to be medical advice on how to deal with a particular situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

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