Hepatitis A is an RNA virus which causes inflammation of the liver. According to national estimates, over 44,000 cases of Hepatitis A infection were detected in India between 2011-2013. This burden is the highest compared to all other vaccine-preventable diseases in the country, excluding Pertussis (whooping cough). In fact, the worldwide mortality of Hepatitis A is more than chicken pox, Tetanus, Diphtheria and Pertussis put together. Fortunately, it is also one of the very few vaccine-preventable causes of liver failure.
Hepatitis A infection can manifest itself as acute hepatitis, especially during the monsoon months (July-October). The illness begins 2 to 7 weeks after the virus has entered the body. Though the infection does not result in chronic liver disease, it can cause acute liver failure in about 1% of the cases with a fatality rate of 44-52%. “Around 40% of children over 10 years of age are susceptible to Hepatitis A in India, but their risk of associated acute liver failure can be completely prevented by vaccination. It is therefore unfortunate that Hepatitis A infection continues to remain the commonest cause of acute liver failure in Indian children,” says Dr. Arti Pawaria, Senior Consultant & Clinical Lead, Dept. of Paediatric Hepatology, Gastroenterology & Liver Transplantation, Amrita Hospital, Faridabad.
Causes of Hepatitis A
Hepatitis A outbreaks have been reported from Kerala, Tamil Nadu, Himachal Pradesh, and Maharashtra, affecting children. The infection mostly spreads through contaminated food or water and inadequate sanitation.
Poor personal hygiene is a major factor, such as when an uninfected person consumes food or water contaminated with the faeces of an infected person.
In families, this might happen through dirty hands when an infected person prepares food for family members. Waterborne outbreaks of Hepatitis A, though infrequent, are usually related to sewage-contaminated or inadequately treated water.
“Hospitalization of the patient is required in case of rapidly declining liver function tests, altered sensorium (drowsiness, coma), symptoms of acute liver failure or excessive vomiting that makes eating or drinking difficult,” adds Dr Pawaria.
Treatment of Hepatitis A infection is only supportive. If irreversible liver failure occurs, liver transplantation is the only option to save the patient’s life.
Ways to prevent
“To protect oneself from Hepatitis A infection, avoid consuming uncooked food such as salads, cut fruits, or fresh juices prepared outside. Do not eat unhygienically prepared food items, especially in the rainy season,” opines Dr Pawaria.
Drink clean, uncontaminated water, and wash your hands regularly before meals and after using the toilet
“The most effective preventive measure against Hepatitis A is to get vaccinated. It is highly recommended that all children receive the Hepatitis A vaccine at 1 year of age for excellent protection against the disease. Unvaccinated older children under the age of 18 years should also receive the vaccine,” believes Dr Pawaria.
Vaccination doses in India
Two types of Hepatitis A vaccines are currently available in India. Vaccination with the inactivated virus vaccine (Havrix) involves two doses of vaccine shots taken 6 months apart. Protection starts 1-2 weeks after the primary dose of vaccine and lasts for 20 years to life after 2 doses. The liver-attenuated vaccine (Biovac A), on the other hand, needs to be taken only once.
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The effectiveness of single dose of Hepatitis A vaccine program to save numerous young lives has already been shown by Argentina in 2006. The Indian government should seriously consider introduction of large-scale Hepatitis A vaccination, as per recommendations of the World Health Organization (WHO). This is especially important considering the epidemiological transition of the country from high to intermediate endemicity due to rapid (but unequal) development and improving standards of hygiene.
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