Hep A vaccine back in focus after outbreaks

Increasing incidence of viral hepatitis A outbreaks in Kerala due to contaminated water sources, unsafe handling of food or poor hand hygiene of food handlers has once again reopened the discussion whether the State needs to introduce universal Hep A vaccination.

In the last decade, Kerala has been experiencing a sizeable number of hepatitis A outbreaks, the majority of which are small outbreaks but which remain underreported and underinvestigated. The frequency of the outbreaks has been going up in recent years, with occasional deaths. The Health department’s Integrated Disease Surveillance Programme reports that this year as of March 3, there have been 1,743 probable cases of hepatitis A and 545 confirmed cases. There have been six suspected/probable hepatitis A deaths and one confirmed death.

The susceptible population in the State is the older age group, especially adolescents and young adults.

Scenario in State

Hepatitis A presents as a selflimiting disease in children. However, in Kerala, it happens mostly in adulthood, when the disease might be severe and could have complications such as fulminant hepatic failure, which could be fatal or nearfatal, requiring liver transplantation, a public health expert points out.

According to the WHO, vaccination is the best way to prevent hepatitis A. The available vaccine’s immunogenic potential and efficacy is proven, with over 95% seroconversion sustained protection for at least two years.

Because hepatitis A virus is hyperendemic in the country, almost 95% of the infections are acquired in childhood itself, rendering children immune to the virus lifelong. For Kerala, universal hepatitis A vaccination could be justified, given the cost of care, morbidity and the increasing frequency of outbreaks.

In fact, a committee, headed by B. Ekbal, set up by the government in 2022 to formulate a vaccine policy for the State had recommended that hepatitis A vaccine at 12 months of age may be adopted for Kerala, of course, after considering feasibility, supply chain and logistical challenges.

But what Dr. Ekbal committee had recommended that the State implement on a shortterm priority basis was that all food handlers and those who work

As of March 3 this year, there have been 1,743 probable hepatitis A cases and 545 confirmed ones

in food processing units be vaccinated against enteric fever and hepatitis A. It was suggested that a uniform mandatory vaccination card be issued to all food handlers.

Mandatory vaccination,

Mandatory hepatitis A vaccination, at least for food handlers, is something the Health department would have to implement sooner in the State’s current situation. Public health experts say the State should focus better on evolving improved surveillance strategies for viral hepatitis outbreaks and scientific outbreak investigations to pinpoint the source of contamination and create public awareness.