Hepatitis A
15.11.2025
Hepatitis A
Context
Public health experts in India are advocating for the inclusion of Hepatitis A vaccination in the Universal Immunisation Programme (UIP) due to rising outbreaks and a decline in natural immunity among adolescents and young adults. This shift is linked to improved sanitation reducing early childhood exposure, causing more adults to be susceptible to severe disease.
About Hepatitis A
- Hepatitis A is an acute viral infection caused by the Hepatitis A Virus (HAV), which inflames the liver.
- It does not cause chronic liver disease but can lead to severe hepatitis or acute liver failure, particularly in adults.
- Transmission is faeco-oral, mostly through ingestion of contaminated food or water, or direct contact via poor hygiene.
- Symptoms include fever, malaise, loss of appetite, nausea, diarrhea, abdominal discomfort, dark urine, and jaundice.
- No specific antiviral treatment exists; hospitalization is for severe cases, and most recover with lifelong immunity.
Key Public Health Concerns
- Historically, most Indians were infected as children, developing mild symptoms and lifelong immunity.
- Improved sanitation has lowered early childhood exposure; thus, immunity in adolescents and adults has decreased from about 90% to less than 60% in many urban areas.
- The shift towards adult infections results in more severe disease and higher risk of acute liver failure.
- Recent outbreaks in states such as Kerala, Maharashtra, Uttar Pradesh, and Delhi underscore the growing risk.
Vaccine and Benefits
- The Hepatitis A vaccine provides 90-95% protection, is safe, and offers long-term immunity (15-20 years or lifelong).
- An indigenous vaccine, Biovac-A (Biological E Ltd.), has been used safely for over two decades in the private sector.
- The single-dose vaccine can be co-administered with existing boosters like DPT or MR.
- Vaccination is cost-effective compared to treating severe adult cases and reduces hospital burden.
Strategic Recommendations
- Phased introduction starting in states with repeated outbreaks or low seroprevalence.
- Conduct periodic serosurveys to monitor immunity levels.
- Utilize existing UIP infrastructure and logistics for efficient rollout.
- Aligns with UIP’s record of successful addition of vaccines like Hepatitis B, Rotavirus, and Pneumococcal.
- Will reduce healthcare costs and prevent avoidable severe disease and hospitalizations.
Conclusion
Including Hepatitis A vaccination in India’s Universal Immunisation Programme is a scientifically justified and public health imperative. It will protect vulnerable adolescents and adults from severe illness, control outbreaks, and reduce the economic burden on the healthcare system. India’s available indigenous vaccine and existing UIP infrastructure present an effective pathway for this inclusion.