Hepatitis B Infection—Child Care and Schools

What is hepatitis B infection?

• Hepatitis B is a viral infection causing liver inflammation.

• The virus can lead to serious illness, lifelong infection, liver failure, and liver cancer.

• Hepatitis B is a blood-borne infection. (See Chapter 1 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition for more details.)

What are the signs or symptoms?

• Flu-like symptoms (eg, muscle aches, nausea, vomiting, fatigue).

• Abdominal pain, especially in the right upper side of the belly (just below the ribs).

• Jaundice (ie, yellowing of skin or whites of eyes).

• Dark urine.

• Loss of appetite.

• Joint pains.

• Tiredness.

• Young children may show few or no signs or symptoms.

• Most people recover fully, but some carry the virus in their blood for a lifetime. Age at the time of infection is a major factor in whether hepatitis B will become a chronic infection. Infants infected prenatally or shortly after birth have a much higher chance of developing chronic infection compared with those infected as older children and adults.

What are the incubation and contagious periods?

• Incubation period: 45 to 160 days; average of 90 days

• Contagious period: As long as the virus is present in the blood of the infected person, which can be for the lifetime of an infected person who is a long-term carrier

How is it spread?

• Most commonly through

  • ? Blood or blood products.

  • ? Sexual contact.

  • ? Children born to infected individuals may become infected during birth.

• Uncommonly through

  • ? Saliva that contains blood.

  • ? Frequent contact with open sores or the fluid that comes from open sores that contains blood.

  • ? Direct exposure to blood through injury, bites, or scratches that break the skin, introducing blood or body fluids from a carrier to another person.

• Hepatitis B virus can remain contagious on surfaces for 7 days or more. The virus is inactivated by commonly used disinfectants.

How do you control it?

• Hepatitis B is a vaccine-preventable disease. Babies should receive vaccine at or soon after birth, with additional doses of the vaccine according to the routine immunization schedule.

• Adults who are expected, as a condition of their employment, to come in contact with blood are required to be offered vaccine by their employers under US Occupational Safety and Health Administration (OSHA) regulations.

• Cover open wounds or sores.

• Do not permit sharing of toothbrushes or pacifiers.

• Standard Precautions (see Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition) should be followed when blood or blood-containing body fluids are handled. For blood and blood-containing substances, these are the same precautions described by OSHA as Universal Precautions.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education (ECE) program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members and the parents of underimmunized children to watch for symptoms and notifies the Child Care Health Consultant.

• Contact the health professional of the child with hepatitis B for a treatment and group management plan.

• If a child with known hepatitis B bites or is bitten by a child who is underimmunized against hepatitis B, the underimmunized child should be referred to a health professional or the local health department, as they might require additional testing or vaccination.

• Routinely check that children complete the hepatitis vaccine series according to the most recent immunization schedule.

• Practice Standard Precautions (see Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition) for handling blood and other body fluids at all times, as carriers of this infection may not be identified to staff members. Check and follow the facility's plan for handling exposure to blood-borne pathogens as required by OSHA.

Exclude from educational setting?

No, unless a child with known hepatitis B exhibits any of the following signs or symptoms. In such cases, admission should be assessed on an individual basis by the child's health care professional in consultation with child care staff members:

• Weeping sores that cannot be covered.

• A bleeding problem.

• Aggressive behavior, including biting or scratching, that would lead to bleeding by the child with hepatitis B.

• Generalized dermatitis that bleeds or oozes body fluids.

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).

Note: Most children with hepatitis B infection should be admitted to an early ECE program or school without restrictions. Children with hepatitis B should be treated the same as other children.

Readmit to educational setting?

Yes, when all the following criteria are met:

• When skin lesions are dry or covered

• When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group