Medical Resources :: Common Diseases :: Infectious Diseases & Parasites :: Hepatitis B and C

Hepatitis B is a viral infection which affects the liver. If the person contracts the infection, it usually resolves within a few weeks and there are no further medical problems. If the person becomes a carrier of the virus, the liver can be chronically inflamed. Cirrhosis and possibly cancer of the liver can develop years into the future. Natural history studies of chronic HBV among children are just beginning to appear in the medical literature. The risk of developing chronic HBV is correlated highly with the age of initial infection. Approximately 90 per cent of those infected prior to 1 year of age develop chronic HBV infection, whereas the rate decreases to approximately 40 per cent between 1 and 10 years of age and is less than 10 per cent among adults.

Hepatitis B can be transmitted from a mother to the newborn infant at the time of birth if the mother is infected and carries the Hepatitis B virus. In China, Hepatitis B is quite prevalent and 5 to 15 per cent of all those individuals infected with Hepatitis B can potentially become carriers of the virus lifelong. Children born to mother's who are carriers are then exposed to the virus at the end of the pregnancy and at the time of delivery. Because mother's frequently do not have prenatal care their carriage status is unknown and when the baby is delivered, the baby is not given Hepatitis B immune globulin and vaccine in an effort to prevent the infection in the newborn. This is standard procedure in the United States. Many orphanages now administer Hepatitis B vaccine, but this vaccine is given much too late to prevent infection from mother to infant at the time of birth. The vaccine will however at least decrease the transmission of the virus in the orphanage.

When little girls are in an orphanage, they are assessed for Hepatitis B virus with a blood test during the first few months that they arrive in the orphanage. On the medical exam, you may see the phrase "Hepatitis B surface antigen". Usually, you will see the word "negative" or a symbol "-" to indicate that the baby is not infected with Hepatitis B virus. Because the incubation period of Hepatitis B may be as long as six months, these results may not accurately reflect the Hepatitis B surface antigen status of your adopted daughter. Children can also be exposed to Hepatitis B virus in the orphanage by exposure to blood from staff members or other children who may be carriers of the virus. This is a blood borne infection and is transmitted in household settings by exposure to blood of the individual who is carrying the virus. An orphanage is equivalent to a household. This virus is not transmitted casually by sharing food or utensils from time to time. I recommend Hepatitis B vaccination for all household members when a family member is a Hepatitis B carrier. If your family consists of other children, they have probably been immunized as infants because Hepatitis B vaccine is required for school entry. Parents traveling to adopt a child abroad should be vaccinated before traveling. The vaccine is a three vaccine series which can be completed within six months. If you have two vaccines before you travel, this will probably afford some protection.

When the child arrives from China, we recommend testing for Hepatitis B which includes Hepatitis B surface antibody, Hepatitis B core antibody, and Hepatitis B surface antigen. If the antigen is positive, then we recommend further evaluation which may include Hepatitis B e antigen and e antibody.

I have evaluated over one hundred adopted Chinese girls over the past few years; the prevalence of Hepatitis B carriage is about 5-7%. All of the children are healthy and most have not required any treatment at this time. A few children have had elevated liver enzymes indicating some inflammation of the liver which has necessitated treatment with interferon. Interferon is a medicine which is injected three times a week for four months. One of the girls is completely free of the virus after treatment! There are many new treatments being studied currently and lots of intensive research is being devoted to the treatment of children and adults with chronic Hepatitis B infection. The future looks good for anyone with chronic Hepatitis B infection.

Hepatitis C, formerly non-A, non-B hepatitis, is fast becoming a worldwide problem. The prevalence of Hepatitis C in the U.S. is probably as high as 2%. Hepatitis C infection is the most common cause for liver transplant in the U.S. Transmission of Hepatitis C (HCV) infection is through injection drug use and transfusion of blood. In the United States, the major mode of transmission of HCV is via injecting-drug use. [Alter 1997; CDC 1998] Perinatal transmission is 5%-7% although it can be higher (40%) for children born to women who are co-infected with HIV. The transmission of HCV infection through breast milk has not been documented. Household contact transmission is very uncommon. The risk factors for HCV infection in internationally adopted children are most likely transfusion, exposure to unsterile needles, and possibly perinatal transmission. Children who are born prematurely may be transfused and there may be no record of this on the medical abstracts that are translated for agencies and families.

Out of almost 1500 children evaluated by me during my almost 10 years doing adoption medicine, there are two children who are infected with HCV and at this time they are both school aged and well-appearing with no signs of chronic active hepatitis. Two children under one year of age who just arrived from abroad are antibody positive, but may turn out to not be infected. This cannot be determined until after the child is at least a year of age. The maternal antibody can persist that long.

These four children are from Eastern Europe and the former Soviet Union. Other adoption medical clinics have also reported cases of HCV. Two children of 129 children assessed in an adoption clinic in Boston between 1989 and 1993 [Miller et al. 1995] were found to have active HCV infection. There was a cluster of 5 cases of HCV in children adopted from China in 1995 from an orphanage in Yangzhou, China in Jiangsu province and two children adopted from China were found to be infected with HCV in a
large New York City practice where well over 400 children adopted from China have been evaluated over the past 5 years. [Traister & Aronson 1998].

The international adoption medicine group has agreed to establish a database to better understand the risk factors for HCV in children adopted from abroad. The complications of HCV are similar to Hepatitis B Virus (HBV): cirrhosis and liver cancer. At this point in time until we establish the epidemiology in children adopted from abroad it is the consensus of adoption medicine specialists that we screen for hepatitis C antibody using a standard enzyme immunoassay (EIA) during the initial routine medical evaluation when a child first arrives in the United States. Hepatitis C antibody (Enzyme immunoassay/EIA), recombinant immunoblot (RIBA), and the polymerase chain reaction for ribonucleic acid (PCR RNA) are tests used to make the diagnosis of HCV. [Gretch 1997] There are limited numbers of treatment regimens available (alpha-interferon alone or in combination with ribavirin) with limited efficacy. [Camma et al. 1996; Carithers & Emerson 1997; National Institutes of Health Consensus Development Conference Panel
Statement 1997; Schalm et al. 1996; Schvarcz et al. 1995;] Newer therapies are under investigation (pegylated interferon, beta interferon, thymosin-alpha 1, n-acetyl cysteine, glutathione, agents to inhibit HCV protease enzyme and helicase, antisense RNA) [Norton 1998]. It might be advisable to repeat the Hepatitis C antibody test six months after arrival in case of exposure to the virus just before leaving the orphanage because
there can be an incubation period as long as six months, although typically the incubation period is 2 weeks to 3 months.

When appropriate treatment regimens become available for children with HCV, we can inform those who have tested positive in the future. This is actually the model adopted by then-Surgeon General, Dr. David Satcher. Letters will be sent by blood banks and hospitals to those most at risk of having received tainted blood transfusions before 1992 when testing for HCV in blood banks first began in this country. [Groopman 1998].