Physician: Hepatitis A and the Institutionalized Child

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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. Slight fever
  3. Jaundice (yellow skin)
  4. Pain in the region of the liver, right upper quadrant, right below the right rib cage.
  5. Enlarged liver
  6. Dark urine
  7. Stool become light and clay colored
  8. Knowledge of local epidemic in the orphanage.
  9. Laboratory studies generally not performed in 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. Once a child is infected with Hepatitis A, there are no specific therapeutic measures. Generally a very light diet is prescribed, low in fates. This help to lower some of the gastro-intestinal symptoms, but it does nothing to cure the disease. The overall prognosis for children is excellent. There is the very rare instance when a child may have fulminant hepatitis and expire.

Currently in the U.S.A. there is a new Hepatitis A vaccine. The current recommendations are to begin immunization for all children between the ages of 12 and 23 months. Older children should receive a primary dose followed by a booster dose of Hepatitis A 6 months later. The primary role of any vaccine is to provide immunity to the person that was immunized. A secondary goal is to provide what is called herd immunity or the fact that others in the herd or population have been vaccinated provides protection to all others, whether or not vaccinated themselves.

Unfortunatly, Hepatitis A vaccine is not given in a majority of the countries that place children for International Adoption. By the time that your adoptive child reaches the United States, he/she will more than likely have already contracted hepatitis A disease and already have immuity to it.

by George Rogu, M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's 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.

This material has been provided by, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit or call 631-499-4114.

Visitor Comments (1)
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rick rick - 3 months ago
I was diagnosed with Hep B way back in 2013 when I was supposed to donate blood to my nephew. It was normal to do laboratory check on my blood hence it was found out that I’m reactive to the illness. I’m very depressed and demoralized since this disease has been unacceptable just like the unpopularity of AIDS. I was so nervous that I’ve got ashamed to talk with other people onward, so my mom subjected me to series of tests so that damage to the liver may be traced. The doctor told me that; YES i am chronic carrier, i was so depressed was thinking of committing suicide, till i came across a forum on internet, about MED LAB TEC who cured various diseases like Hepatitis B, Herpes, liver fluke HIV and others, without wasting time, i contacted them and i get medication from them and after the days given to me, I just went back to my doctor and they also carry out the test again, and i was negative of Hepatitis B. Please contact this MED LAB TEC if you are hepatitis B positive or any k #1

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