Hepatitis A and Hepatitis B: What Every Parent Needs to Know

A Q&A with Le Bonheur Pediatrics Physician Dr. Stephen Bauch

When it comes to protecting your child’s health, it’s natural to have questions, especially about infections that affect the liver, like hepatitis A and hepatitis B. While both are preventable and manageable, they spread in very different ways and carry different risks for children.

To help parents better understand these common illnesses, we spoke with Dr. Stephen Bauch, a pediatrician with Le Bonheur Pediatrics. In this Q&A, he breaks down what hepatitis A and B are, how they spread, what symptoms to watch for and how immunizations play a powerful role in keeping kids safe.

From why young children can unknowingly spread hepatitis A to why the hepatitis B immunization starts at birth, here is what every parent needs to know.

Understanding Hepatitis A

What is Hepatitis A?

Hepatitis A is a very easy-to-spread infection that affects your liver. It’s caused by a virus that causes liver inflammation and stops it from working like it should.

The virus is very tough and can live on surfaces like doorknobs and toys for weeks.

How does it make kids sick?

Most young children who get hepatitis A don't even look sick. About 70 percent of children younger than 6 years old have no symptoms at all. When older kids and adults get it, they usually feel much sicker.

When symptoms do appear, usually two to four weeks after catching the virus, they can include:

• Fever and feeling tired
• Loss of appetite, nausea and vomiting
• Stomach pain
• Dark-colored urine (pee)
• Jaundice (yellowing of the skin and eyes)
• Diarrhea

Most people feel better within two to three months, though some may have symptoms that come and go for as long as six months.

How serious is Hepatitis A?

The good news: hepatitis A is usually mild, especially in children. It never becomes a long-term infection, and once you recover, you're protected for life. Serious liver problems are very rare; less than one in 100 people develop severe liver failure, and this is more common among adults older than 40.

How does it spread?

Your child can catch hepatitis A from:

• Eating food or drinking water contaminated with the virus
• Close contact with someone who has the infection such as sharing food or drinks
• Touching contaminated surfaces and then touching your mouth

Here's the tricky part. Children are most contagious in the two weeks before they show any symptoms. This is why young kids who seem healthy can easily spread it to family members and other children.

How can we prevent the spread of hepatitis A?

The best ways to protect your family are to:

• Get your child immunized. This is the most effective way to protect your child.
• Wash hands thoroughly with soap and water, especially after using the bathroom and before eating.
• Clean and disinfect surfaces regularly, especially in bathrooms and kitchens.
• Avoid sharing food, drinks or utensils with someone who is sick.

The Hepatitis A Immunization

How many shots are needed?

The hepatitis A immunization is administered by two shots, given six months apart.

When should children get immunized?

The American Academy of Pediatrics (AAP) recommends that all children get their first hepatitis A shot between 1 to 2 years old. The second shot comes six months later. If your child misses these shots, they can catch up at any age through adulthood.

Will booster shots be needed later?

The two-dose series provides long-lasting protection, likely for 30-40 years. No booster shots should be needed.

How well does the immunization work?

The hepatitis A immunization works extremely well. Studies show it prevents hepatitis A infection in 94-100 percent of children. After two doses, more than 95 percent of children develop complete protection. This means the vaccine doesn't just make the illness milder. It prevents infection!

Is the immunization safe?

Yes, the hepatitis A immunization has an excellent safety record. The most common side effects are mild and include:

• Soreness, redness or swelling where the shot was given, about one in three children
• Mild fussiness or irritability, about four in 10 young children
• Low-grade fever is less common
• Drowsiness or decreased appetite

These side effects usually go away within a day or two. Serious reactions are extremely rare.

Understanding Hepatitis B

What is hepatitis B, and how is it different from hepatitis A?

Hepatitis B is also a virus that infects the liver, but it's very different from hepatitis A in important ways:

How it spreads: Hepatitis B spreads through blood and body fluids, not through food or water. It can pass from an infected mother to her baby during birth, through contact with infected blood or through sexual contact.

The biggest difference: Hepatitis B can become a lifelong chronic infection, especially in babies and young children.

How does it make kids sick?

Most babies and young children infected with hepatitis B don't show any symptoms at first. When symptoms do occur, one to six months after infection, they can include:

• Fatigue and weakness
• Loss of appetite, nausea and vomiting
• Stomach pain
• Fever and joint pain
• Jaundice, yellowing skin and eyes

Why is it so dangerous for babies and children?

Here's what makes hepatitis B especially dangerous for babies and young children:

• 90 percent of babies infected at birth develop life-long infection
• 25-50 percent of young children, ages 1-5, who are infected develop chronic infection
• Less than 5 percent of adults who are infected develop chronic infection

This is why immunizing babies right after birth is so important! 

What happens with chronic infection?

Children with chronic hepatitis B often feel fine for years, but the virus quietly damages their liver over time. Without treatment, 15-40 percent of people with chronic infection will eventually develop serious liver problems like scarring of the liver or liver cancer, which can happen decades later.

How does hepatitis B spread?

Babies and children can get hepatitis B from:

• Birth: From an infected mother during delivery, the most common way babies get infected.
• Blood contact: Sharing toothbrushes, razors or contact with open sores
• Contaminated medical equipment: This is very rare in the United States

The virus is very contagious, more contagious than HIV, and can survive on surfaces for at least a week.

How can we prevent the spread of hepatitis B?

• Immunize your baby within 24 hours of birth. This is the most important step.
• All pregnant women are tested for hepatitis B to protect their babies.
• Don't share personal items like toothbrushes or razors.
• Cover cuts and scrapes with bandages.
• Clean up blood spills with gloves and bleach solution.

The Hepatitis B Immunization

How many shots do children need?

Most children will receive three shots given throughout a six-month period.

When should children get immunized?

American Academy of Pediatrics (AAP) recommends:

• First shot: Within 24 hours of birth in the hospital
• Second shot: At 1-2 months old
• Third shot: At 6 months old

Starting immunization right after birth is crucial because it prevents 90 percent of babies born to infected mothers from developing lifelong infection.

Will booster shots be needed in the future?

For most people, no booster shots are needed. The three-dose series provides protection for 30 years or more, likely for life. Your child's immune system "remembers" the immunization even if antibody levels decrease over time.

How well does the immunization work, and is it safe?

The hepatitis B immunization is highly effective. After completing all three doses, more than 95 percent of babies, children and young adults develop complete protection. Like the hepatitis A vaccine, it prevents infection rather than just reducing symptoms.

The hepatitis B immunization has been used safely since 1981. The most common side effects are mild:

• Soreness where the shot was given, about one in four children
• Mild fussiness or irritability
• Low-grade fever, one to six percent of children

Serious allergic reactions are extremely rare, about one in 1.1 million doses. Multiple large studies have shown no link between the hepatitis B immunization and chronic diseases, autism or other serious conditions. In fact, studies of the immunization have not only shown a drop in childhood infections, but also a decrease in liver cancer rates in young adults.