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Picture Courtesy: The Hindu

Context:

Hepatitis A is becoming a growing health problem in India. It is a disease that spreads quietly, often without warning, and can cause serious liver complications in older children and adults.

What Hepatitis A is?

Hepatitis A is a viral infection that causes inflammation of the liver. It is caused by the Hepatitis A virus (HAV), a small and hardy virus that survives well in the environment. It spreads easily from person to person, especially where sanitation and clean water systems are weak.

Unlike some other hepatitis viruses (like B and C), Hepatitis A does not cause long-term chronic infection. It is usually an acute, short-term illness. However, in certain age groups—particularly adolescents and adults—it can cause severe symptoms.

Common sources of infection include:

• contaminated water supplies
• unsafe food handling
• street foods washed in impure water
• close contact with an infected person
• poor sanitation or hygiene practices

How the disease behaves in different age group?

In early childhood

• Infection is often mild or without symptoms.
• Most children recover fully.
• They gain lifelong immunity.

In adolescents and adults

• Disease is more visible and more severe.
• Risk of acute liver failure
• Hospitalisation is often needed.

Symptoms:

Symptoms typically appear 2–6 weeks after infection, which includes;

• fever
• tiredness
• nausea and vomiting
• stomach discomfort
• dark urine
• yellowing of the eyes and skin (jaundice)
• loss of appetite

Current Status of Hepatitis A cases:

• According to the National Viral Hepatitis Control Program (NVHCP) / government’s “National Guidelines for Diagnosis and Management of Viral Hepatitis,” the data on Hepatitis A (HAV) accounts for 10–30% of acute hepatitis cases and 5–15% of acute liver failure (ALF) cases in India.
• A 2021 nationwide seroprevalence study found that among people aged 6–30 years, 90% had IgG antibodies against HAV. Based on WHO classification, India falls in the “intermediate endemicity” category for HAV.

Why Hepatitis A should be included in India’s Universal Immunisation Programme?

The Key reasons are;

Disease patterns in India have changed

Earlier:

Most children got infected early in life. Illness was mild, and they became immune forever.

Now:

Improved sanitation means fewer children are exposed.
This leads to:

• lower natural immunity in the population
• more teenagers and adults susceptible
• higher chances of severe symptoms
• more outbreaks in cities and towns

Outbreaks in states like Kerala, Maharashtra, Uttar Pradesh, and Delhi show this clear shift.

Adults get much more severe disease

Hepatitis A in young children is mild.
But when older children and adults get infected, the disease can be dangerous.

Serious complications include:

• acute liver failure
• prolonged jaundice
• hospitalisation
• occasional deaths

Since more adults are now vulnerable, disease severity and the burden on hospitals have increased.

No specific treatment exists

Unlike typhoid, Hepatitis A has no direct cure or antiviral medicine.
Treatment is only supportive, meaning:

• rest
• hydration
• monitoring liver function

This makes prevention through vaccination the safest and most effective strategy.

Vaccine is extremely safe, effective, and long-lasting

Hepatitis A vaccines:

• offer 90–95% protection
• give long-term—often lifelong—immunity
• work well even with a single dose (for the live vaccine)
• have excellent safety records over decades

This makes Hepatitis A one of the simplest diseases to prevent through vaccination.

India already has an indigenous, proven vaccine

India produces its own Hepatitis A vaccine (Biovac-A) that has been:

• used in the private sector for over 20 years
• safe and effective
• affordable
• easy to store and administer

The vaccine is ready for mass use—policy inclusion is the only missing step.

Increasing Outbreaks Put Pressure on Health Systems

Urban areas and developing regions are seeing:

• frequent outbreaks
• contaminated food- and water-linked clusters
• rising cases of liver failure in young adults

Vaccination can significantly reduce outbreaks and prevent unexpected health crises in communities.

Challenges in including Hepatitis A in India’s Universal Immunisation Programme:

• Limited national-level burden data: One of the biggest barriers is the lack of clear, nationwide, up-to-date data on Hepatitis A burden. Many hepatitis cases reported through government surveillance are not tested to confirm whether they are A, E, B, or C. India has only sporadic seroprevalence studies, not continuous, high-quality national surveillance. 

• Perception that Hepatitis A is mild: Historically, Hepatitis A in India was considered a benign childhood disease. Hepatitis A can cause liver failure in older children and adults, but this shift is not widely recognised in public health planning. 

• Competing Vaccine Priorities
• India’s UIP already struggles with:
• Polio endgame requirements
• Measles and rubella elimination
• Pneumococcal and rotavirus vaccine rollout
• Introduction of typhoid conjugate vaccine (TCV)
• HPV vaccine expansion 

• Cost concerns for mass vaccination: Even though Hepatitis A vaccines are safe and effective, they are not the cheapest vaccines. Government budgets are limited, and cost-effectiveness calculations require strong data—which is currently insufficient. 

• Uneven Endemicity Across India: India shows mixed epidemiological patterns; Some states have high immunity (many adults already exposed). Some show sharp declines in natural immunity (urban areas, Kerala, Maharashtra, Delhi), this creates confusion.

Government Measures:

National Viral Hepatitis Control Programme (NVHCP)

NVHCP is India’s largest government-led programme to tackle hepatitis A, B, C, D, and E.

Main objectives

• Reduce morbidity and mortality related to viral hepatitis
• Achieve elimination of hepatitis by 2030 (aligned with WHO goals)
• Provide free screening, diagnosis, and treatment for hepatitis B & C
• Strengthen public health systems for prevention of HAV & HEV outbreaks

Key components of NVHCP

• Free testing and treatment for Hepatitis B & C at district hospitals
• Surveillance and outbreak investigation for Hepatitis A & E
• Vaccination support (especially Hepatitis B birth dose & high-risk groups)
• Public awareness campaigns
• Training of healthcare workers
• Improving water, sanitation, and hygiene (WASH) components through state coordination

Flagship Programs

• Jal Jeevan Mission (JJM): Safe drinking water to all rural households
• Swachh Bharat Mission (SBM): Improved sanitation, toilet access
• National Rural Drinking Water Programme: Monitoring and testing water quality
• Urban sanitation programmes reducing open defecation and contamination 

Policy & guidelines issued

Ministry of Health & Family Welfare (MoHFW) has published several guidelines:

• National Guidelines for Diagnosis & Management of Viral Hepatitis
• Operational Guidelines for NVHCP
• Outbreak investigation guidelines for Hepatitis A & E
• Guidelines on safe injection practices
• Birth-dose Hepatitis B guidelines

Way Forward:

Strengthen national surveillance for Hepatitis A

• Improve testing of acute hepatitis cases so that the type of virus is accurately identified.
• Expand laboratory capacity across the country to detect Hepatitis A early. 

Introduce Hepatitis A vaccination in phases

• Begin vaccination in states that frequently report outbreaks, such as Kerala, Maharashtra, Delhi, and Uttar Pradesh.
• Include the vaccine as part of routine immunization for children around 12 to 18 months of age. 

Improve Water and Sanitation Measures

• Ensure safe drinking water through national and state water programs.
• Regularly test water quality in urban and semi-urban areas, especially before monsoon season.

Raise Public Awareness

• Conduct campaigns focusing on hand-washing, safe water, and food hygiene.
• Use schools, colleges, workplaces, and community centers to share simple messages about hepatitis prevention.

Enhance Coordination Between Central and State Governments

• States should identify outbreak hotspots and share data with central authorities.
• Provide technical support and guidance for targeted vaccination and outbreak control.

Conclusion:

Hepatitis A is emerging as a serious public health concern in India, especially among older children and adults. With safe and effective vaccines available, improved sanitation, and growing awareness, a preventive approach is both feasible and urgent. Strengthening surveillance, promoting hygiene, and introducing phased vaccination can protect vulnerable populations and reduce the burden of the disease nationwide.

Source: The Hindu