Hepatitis A and India’s Universal Immunisation Programme (UIP)

Context

1. India is debating whether to include the Typhoid Conjugate Vaccine (TCV) in the Universal Immunisation Programme (UIP).
2. This has triggered a wider discussion on whether Hepatitis A, which is causing rising outbreaks and severe liver failure among adolescents and young adults, actually deserves higher priority.
3. Although India already has a safe and effective indigenous Hepatitis A vaccine, it still has not been added to UIP.

What is Hepatitis A?

1. Hepatitis A is a viral infection of the liver transmitted through contaminated food or water.
2. Key aspects:
   1. Earlier, almost all Indian children got mild Hepatitis A naturally, which gave lifelong immunity.
   2. With improved sanitation, fewer young children are exposed early → leaving older children and adults unprotected.
   3. In adolescents and adults, Hepatitis A can cause severe disease, acute liver failure, and even death.
   4. There is no specific treatment; recovery depends on supportive care.

Why is Hepatitis A an Emerging Public-Health Threat?

1. Multiple outbreaks recorded in Kerala, Maharashtra, Uttar Pradesh, Delhi.
2. Hospitals have reported clusters of acute liver failure.
3. Protective antibodies in the population have declined from 90% earlier to below 60% in many urban regions.
4. The disease now affects older children and young adults, where severity is much higher.
5. Typhoid mortality can be controlled using antibiotics, but Hepatitis A has no specific cure.

How Can Hepatitis A be Prevented? (Vaccination Scenario)

1. India already has proven vaccines:
   1. Live-attenuated vaccine (Biovac-A) developed by Biological E: safe, effective, widely used for 20+ years.
   2. Inactivated vaccines are also available.
2. Protection levels: 90-95%, lasting 15-20 years, often lifelong.
3. A single dose of the live vaccine provides durable protection.
4. No concerns of antibiotic resistance, waning immunity, or carrier states (unlike typhoid).

What is the Universal Immunisation Programme (UIP)?

1. The Universal Immunisation Programme (UIP) is India’s flagship vaccination programme launched in 1985 to provide free vaccines to all children and pregnant women.
2. It aims to protect against life-threatening diseases such as polio, measles, diphtheria, tetanus, hepatitis B, tuberculosis, and others.
3. UIP is one of the largest immunisation programmes in the world, covering nearly 7 crore newborns and 3 crore pregnant women each year.
4. Under UIP, vaccines are provided free of cost through government health facilities across the country.
5. The programme follows a phased, evidence-based approach to adding new vaccines (e.g., hepatitis B, rotavirus, pneumococcal).
6. UIP has played a key role in major public-health achievements such as polio eradication and reducing child mortality.

Implications

1. Rising Hepatitis A cases mean rising hospitalisations, economic burden, and higher mortality in young adults.
2. Outbreaks disrupt public health systems and increase healthcare expenditure.
3. Adding Hepatitis A vaccine to UIP can prevent future outbreaks and reduce long-term liver-related complications.
4. Indigenous vaccine availability strengthens vaccine self–reliance and affordability.

Challenges and Way Forward

Conclusion

Hepatitis A is no longer a harmless childhood infection in India, it is a rising cause of severe liver failure among adolescents and young adults. With strong scientific evidence, high disease burden, and a safe indigenous vaccine readily available, including Hepatitis A in the Universal Immunisation Programme is a logical and cost-effective next step. Prioritising this vaccine will strengthen India’s public-health preparedness and continue UIP’s legacy of preventing avoidable illness and saving lives.