Hepatitis A is an acute inflammatory liver disease caused by hepatitis A virus (HAV) infection from close contact with infected people. It is considered to be highly endemic in the Indian subcontinent. Owing to poor sanitation, most of the population gets exposed to the virus in childhood. Epidemiological surveys suggest that seroprevalence is up to about 90% in children. It is usually asymptomatic in childhood and further offers lifelong immunity against the disease.  However, due to increased socioeconomic development, some of the population is reaching adolescence or adulthood without prior exposure to the virus and becomes susceptible to infection, which then gets symptomatic and even leads to mortality.

 Survey data collected between 2014 and 2017 revealed that 12.6% of suspected viral hepatitis cases were due to HAV across India. HAV was the leading cause of viral hepatitis in 29.5% cases in children and 17.9% cases in adolescents. Major proportion of cases were found in the southern region (22.4%), and the monsoon season had higher HAV positivity rates. The incidence of HAV-induced acute viral hepatitis increased remarkably in children, adolescents and adults with time from 1999 to 2003 whereas it was decreased in < 5 years (75%) and increased in 6–15 years (70.8%). 

Therefore, protection of children is vital in decreasing outbreaks and clinical HAV-induced AVH predominantly found in adolescents and adults. Improving hygiene conditions and providing access to safe drinking water aids in reducing HAV transmission. Additionally, screening and vaccinating is the most accepted approach used in India to provide long-term protection against hepatitis A.

Source: Agrawal A, Singh S, Kolhapure S, Hoet B, Arankalle V, Mitra M. Increasing Burden of Hepatitis A in Adolescents and Adults and the Need for Long-Term Protection: A Review from the Indian Subcontinent. Infect Dis Ther. 2019;8(4):483-497.