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Chronic Hepatitis B (in Children)
Diagnosis/Definition
- Any patient should be considered at risk for chronic hepatitis B if they test positive for Hep B surface antigen.
- If a child tests positive for the presence of hepatitis B surface antigen for a period of more than 6 months, he/she is chronically infected and in a carrier state.
Initial Diagnosis and Management
- Any patient with signs and symptoms compatible with acute hepatitis should undergo a full hepatitis panel screening for hepatitis A, B, and C.
- Any patient who was born to a mother with hepatitis B or C, or who has had household contact with hepatitis B or C patients, should be referred to pediatric infectious disease for ongoing evaluation and management.
Ongoing Management and Objectives – Suspected Hepatitis B
- Liver function tests should be performed, and the patient should be counseled regarding their infectiousness to others.
- Unvaccinated family members and sexual contacts should be evaluated for hepatitis B infection. If exposure is within the window of effectiveness for prophylaxis (reference: American Academy of Pediatrics, Red Book 2003. Online version is only available for MAMC users via MAMC Medical Library, Electronic Books), they should receive HBIG prophylaxis. They should receive the first dose of hepatitis B vaccine promptly if not previously vaccinated.
- A full Hepatitis panel to include Hep B Hep BsAg, Hep BsAB, Hep BcAB should be obtained.
Indications for Specialty Care Referral
Any patient diagnosed as above as a carrier for hepatitis B should be referred to the Pediatric Infectious Disease clinic for an intake evaluation on a routine basis.
Criteria for Return to Primary Care
Hepatitis B carriers may continue to be followed by primary care providers for all of their needs. They should be seen every 6 months by Pediatric Infectious Disease service and have LFTs performed monthly by their primary health care providers for the first 6 months.
Pediatric Infectious Disease Service will identify candidates for liver biopsy and also monitor AFP and liver ultrasound results on a routine basis.
