Hepatitis A and Typhoid: Vaccine Inclusion in India's Immunisation Programme
As India considers including the typhoid conjugate vaccine (TCV) in its Universal Immunisation Programme (UIP), there is also a pressing need to prioritize the Hepatitis A vaccine due to its significant public health impact.
Current Challenges and Trends
- India's UIP has been successful in eradicating polio and reducing measles deaths, highlighting its potential for addressing current health challenges.
- While typhoid remains a concern with India bearing half of the world's burden, Hepatitis A has emerged as a growing cause of acute liver failure.
Hepatitis A: A Growing Concern
- Historically, Hepatitis A infected most Indians in early childhood with mild symptoms, offering lifelong immunity.
- Improved sanitation means fewer children are exposed early, leaving many adolescents and adults unprotected, resulting in more severe outbreaks.
- Recent outbreaks in Kerala, Maharashtra, Uttar Pradesh, and Delhi highlight this shift.
- Seroprevalence studies show a decline in protective antibodies from 90% to less than 60% in urban areas.
Vaccine Efficacy and Benefits
- Hepatitis A is preventable with live-attenuated and inactivated vaccines offering over 90-95% protection.
- India’s indigenous Biovac-A vaccine has shown excellent safety and efficacy for more than two decades.
- The vaccine provides long-lasting immunity without issues of waning immunity, antibiotic resistance, or carrier states.
Comparative Analysis: Typhoid vs. Hepatitis A
- Typhoid mortality has decreased with antibiotics and improved sanitation, but antimicrobial resistance remains a concern.
- Hepatitis A affects all socio-economic groups and lacks specific treatment, posing a substantial health risk to older children and young adults.
Strategic Recommendations
- Hepatitis A vaccination should begin in states with repeated outbreaks or declining antibody prevalence.
- The vaccine can be co-administered with existing boosters like DPT or MR.
- A phased approach with periodic serosurveys can guide the expansion of vaccination programs.
This is not an argument against typhoid vaccination, but a call for rational sequencing, as Hepatitis A control is more cost-effective and urgent at this stage. India’s immunisation programme has shown foresight in the past, and adding Hepatitis A would be a logical step forward.
Dr. Vipin M. Vashishtha, former national convener, IAP Committee on Immunisation.