Rising Hepatitis A outbreaks spark call for UIP inclusion
Public health experts are urging policymakers to include the Hepatitis A vaccine in India’s Universal Immunisation Programme (UIP). The push comes amid rising outbreaks across several states, concerns about waning natural immunity among adolescents, and the potential for severe illness in vulnerable groups. Incorporating Hepatitis A vaccination into the UIP could standardize access, reduce transmission, and protect communities, especially in regions with lower sanitation standards and crowded conditions.
What is Hepatitis A and why now?
Hepatitis A is a highly contagious liver infection caused by the Hepatitis A virus (HAV). It spreads primarily through contaminated food and water or close contact with an infected person. While many infections are mild, some can lead to serious illness, prolonged jaundice, or hospitalization. In countries with improving hygiene, immunity from natural infections can decline in adolescence, creating a vulnerable population that may face outbreaks when contaminated food supplies or water sources fail. The current pattern in India shows clusters of outbreaks in urban and rural areas alike, underscoring the need for a preventive approach that reaches all children and adolescents.
Why UIP inclusion makes sense
The UIP already delivers essential vaccines to millions of children nationwide. Adding the Hepatitis A vaccine would leverage existing delivery infrastructure, cold-chain networks, and community health workers to increase coverage, particularly among populations at higher risk due to sanitation gaps. Immunization in early childhood or adolescence can significantly reduce HAV transmission, lowering outbreak frequency and protecting other vaccine-preventable disease programs from potential health system strain during spikes in illness.
Expected public health benefits
- Higher population immunity leading to fewer outbreaks and milder disease burden.
- Protection of vulnerable groups, including adolescents, pregnant people, and those with chronic liver conditions.
- Economic benefits from reduced healthcare costs and fewer work or school absences during outbreaks.
- Strengthened equity by ensuring rural and underserved communities receive the vaccine at the same scale as urban areas.
Implementation considerations
Adopting Hepatitis A vaccination into the UIP would require careful planning to optimize impact:
- Age window: Determine the most cost-effective age for vaccination, typically early childhood or early adolescence, based on local epidemiology and seroprevalence data.
- Vaccine schedule: Decide whether a single-dose regimen suffices in the Indian context or if a two-dose schedule is required for longer-lasting immunity.
- Cold chain and logistics: Ensure vaccine storage is maintained across diverse terrains, leveraging existing UIP infrastructure.
- Public acceptance: Conduct community engagement campaigns to address vaccine hesitancy and explain benefits clearly.
- Monitoring and safety: Strengthen vaccine safety surveillance to track adverse events and maintain trust.
Learning from global experiences
Several countries have integrated Hepatitis A vaccination into their routine immunization schedules with positive outcomes, especially in areas with significant outbreaks. India can tailor strategies using pilot programs to identify best practices in delivery, acceptance, and effectiveness before scaling nationally. Partnerships with state governments, civil society, and healthcare providers will be crucial for success.
Policy path forward
For Hepatitis A vaccination to be included in the UIP, policymakers should review disease burden data, cost-effectiveness analyses, and implementation readiness. Transparent, data-driven decision-making is essential to address regional disparities and ensure that the most vulnerable populations gain timely protection. A phased rollout—starting in high-risk states or districts—could build momentum and demonstrate impact, paving the way for nationwide adoption.
Conclusion
With rising HAV outbreaks and changing immunity profiles among adolescents, integrating Hepatitis A vaccination into India’s UIP represents a pragmatic step toward stronger public health protection. It aligns with national goals of universal coverage, disease prevention, and health equity, while potentially reducing the health and economic toll of Hepatitis A across the country.
