What's New -- Part 2: Viral Hepatitis in Children

Hepatitis C, D, E, and G in Children

Ravi Jhaveri, MD

Disclosures

July 06, 2011

In This Article

Hepatitis D in Children

A 15-year-old boy with known hepatitis B infection has been asymptomatic and doing well living the life of a typical teenager. One week ago he developed fever accompanied by nausea, vomiting, mild abdominal pain, and lethargy. Both he and his mother assumed he had a "bug" and he was treated symptomatically. Over the course of the next several days, his fever resolved though he continued to be anorexic and lethargic with intermittent complaints of nausea. He now has developed jaundice associated with dark-colored urine.

What is most likely the cause of these symptoms?

Clinical Picture of Hepatitis D

Hepatitis delta or hepatitis D (HDV) is a replication-defective RNA virus and requires coinfection with hepatitis B virus (HBV) to complete the assembly of its viral particles. HDV is found worldwide, but the prevalence varies in different geographical areas. HDV infection in the United States is relatively uncommon, though prevalence in intravenous drug users may be between 1%-10%. As with HBV, HDV transmission is via infected blood and blood products. The exception is vertical transmission during pregnancy, which does not occur.[4]

Infection with HDV can occur at the time of the initial coinfection with HBV, or as a superinfection in a person previously infected with HBV. If acquired as an initial coinfection, symptoms usually resolve and immunity is long lasting. Individuals who acquire HDV when already infected with HBV infection are more likely to develop chronic infection and more severe symptoms. HDV acquired either concurrently with HBV or as a later coinfection presents with acute signs of hepatitis including jaundice, fever, and abdominal pain. It can present with acute signs in a patient with HBV who otherwise was doing well. The clinical course of this superinfection is depicted in Figure 3.

Figure 3. Clinical course: HBV-HDV superinfection.
From the Centers for Disease Control Division of Viral Hepatitis. Viral Hepatitis Resource Center.[5]

Diagnosis and Management of HDV

HDV should be considered in any person with a history of HBV who develops acute symptoms. Serologic testing for HDV is available. There is no specific treatment for HDV infections and immunosuppressive therapy and antiviral drugs have all proved ineffective.

Prevention of HDV-HBV coinfection centers around appropriate use of HBV vaccine or postexposure prophylaxis. Chronic HBV carriers should be educated about transmission and high-risk behaviors.

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