Pediatric Infectious Disease

Register      Login

VOLUME 1 , ISSUE 4 ( October-December, 2019 ) > List of Articles

REVIEW ARTICLE

Clinician's Perspective on the Use of Hepatitis A Vaccine in Indian Children

Chetan Trivedi, Sanjay Marathe, Nishchal Bhat, Archana Karadkhele, Gaurav Puppalwar, Rishi Jain

Keywords : Hepatitis A, Immunogenicity, Killed/inactivated vaccine, Live vaccine

Citation Information : Trivedi C, Marathe S, Bhat N, Karadkhele A, Puppalwar G, Jain R. Clinician's Perspective on the Use of Hepatitis A Vaccine in Indian Children. Pediatr Inf Dis 2019; 1 (4):148-153.

DOI: 10.5005/jp-journals-10081-1228

License: CC BY-NC 4.0

Published Online: 23-07-2020

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Hepatitis A, a waterborne endemic disease, is an important cause of acute viral liver disease in Indian children. Although self-limiting in most cases, hepatitis A can rarely cause life-threatening acute hepatic failure. It is the most common attributable cause for acute liver failure in children in countries of high endemicity. Changing epidemiology of hepatitis A in India has resulted in the coexistence of heterogeneous pockets of exposed and unexposed individuals in different social classes and regions. Epidemiological transition has also resulted in higher risk of hepatitis A infection and complications in older children and adults. Vaccines are the time tested and effective measures for prevention of hepatitis A infection; however, despite available vaccines, hepatitis A remains an important public health problem in India because of low vaccination coverage. Currently, two types of vaccines are available for prevention of hepatitis A: live attenuated vaccine and killed/inactivated vaccines. Live vaccine provides robust and long-term immunogenicity due to both humoral and cellular responses, unlike mostly humoral response with killed vaccines. Differences also exist in the schedule and route of administration of these vaccines. Live attenuated vaccine is administered subcutaneously and offers several advantages over killed vaccine including convenience, potential for better compliance, less cost due to single-dose administration and less pain. In patients with bleeding disorder, subcutaneous administration can result in less chances of bleeding when compared with intramuscular administration. Moreover, published long-term immunogenicity data in Indian subjects are available only with live vaccine. In this article, we discuss the clinician\'s perspective on the use of hepatitis A vaccine in Indian children.


PDF Share
  1. Girish N, Sunil B, Ranganatha A. Devaranavadagi A clinical study of viral hepatitis in children: a prospective hospitalbased study. Int J Contemp Pediatr 2018;5(2):563–568. DOI: 10.18203/2349-3291.ijcp20180555.
  2. Das AK. Changing seroepidemiology of hepatitis A infection and its prevention in endemic regions. Int J Health Allied Sci 2016;5(2):75–80. DOI: 10.4103/2278-344X.180427.
  3. Arankalle V, Mitra M, Bhave S, et al. Changing epidemiology of hepatitis A virus in Indian children. Vaccine: Development and Therapy 2014;4:7–13.
  4. Verma YS, Rajput N, Rajput SS. Seroprevalence of hepatitis A virus infection in different age groups of children. Ann Trop Med Public Health 2014;7(5):223–226. DOI: 10.4103/1755-6783.154825.
  5. Chitambar SD, Chadha MS, Joshi MS, et al. Prevalence of hepatitis A antibodies in Western Indian population: changing pattern. Southeast Asian J Trop Med Public Health 1999;30(2):273–276.
  6. Murhekar MV, Sehgal SC, Murhekar KM, et al. Changing scenario of hepatitis A virus and hepatitis E virus exposure among the primitive tribes of Andaman and Nicobar Islands, India over the 10-year period 1989–1999. J Viral Hepat 2009;9(4):315–321. DOI: 10.1046/j.1365-2893.2002.00355.x.
  7. Mathur P, Arora NK. Epidemiological transition of hepatitis A in India: issues for vaccination in developing countries. Indian J Med Res 2008;128(6):699–704.
  8. Matheny SC, Kingery JE. Hepatitis A. Am Fam Physician 2012;86(11):1027–1034.
  9. Arankalle V, Tiraki D, Kulkarni R, et al. Age stratified anti-HAV positivity in Pune, India after two decades: Has voluntary vaccination impacted overall exposure to HAV? J Viral Hepat 2019(6). DOI: 10.1111/jvh.13074.
  10. WHO position paper on hepatitis A vaccines – June 2012 Weekly Epidemiological Record. 2012;28-29:261–276.
  11. Jeong S-H, Lee H-S. Hepatitis A: clinical manifestations and management. Intervirology 2010;53(1):15–19. DOI: 10.1159/000252779.
  12. Hepatitis A. WHO. https://www.who.int/news-room/fact-sheets/detail/hepatitis-a. Accessed on 30th January 2019.
  13. Hepatitis A vaccine information sheet. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-a.pdf accessed on 10th January 2019.
  14. Xu ZY, Wang XY. Live attenuated hepatitis A vaccines developed in China. Hum Vaccin Immunother 2014;10(3):659–666. DOI: 10.4161/hv.27124.
  15. Chen Y, Zhou C-L, Zhang X-J, et al. Immune memory at 17-years of follow-up of a single dose of live attenuated hepatitis A vaccine. Vaccine 2018;36(1):114–121. DOI: 10.1016/j.vaccine.2017.11.036.
  16. Zhuang F, Jiang Q, Gong Y. Epidemiological effects of live attenuated hepatitis A vaccine (H(2)-strain): results of A 10-year observation. Zhonghua Liu Xing Bing Xue Za Zhi 2001;22(3):188–190.
  17. Zhuang FC, Qian W, Mao ZA, et al. Persistent efficacy of live attenuated hepatitis A vaccine (H2-strain) after a mass vaccination program. Chin Med J (Engl) 2005;118(22):1851–1856.
  18. Zhuang FC, Mao ZA, Jiang LM, et al. Long-term immunogenicity and effectiveness of live attenuated hepatitis A vaccine (H2-strain)-a study on the result of 15 years’ follow up. Zhonghua Liu Xing Bing Xue Za Zhi 2010;31(12):1332–1335.
  19. Plumb ID, Bulkow LR, Bruce MG, et al. Persistence of antibody to hepatitis A virus 20 years after receipt of hepatitis A vaccine in Alaska. J Viral Hepat 2017;24(7):608–612. DOI: 10.1111/jvh.12676.
  20. Bhave S, Sapru A, Bavdekar A, et al. Long-term immunogenicity of single dose of live attenuated hepatitis A vaccine in Indian children. Indian Pediatr 2015;52(8):687–690. DOI: 10.1007/s13312-015-0697-8.
  21. Faridi MM, Shah N, Ghosh TK, et al. Immunogenicity and safety of live attenuated hepatitis a vaccine: A multicentric study. Indian Pediatr 2009;46:29–34.
  22. Mitra M, Shah N, Faridi MMA, et al. Long term follow-up study to evaluate immunogenicity and safety of a single dose of live attenuated hepatitis a vaccine in children. Human Vaccines & Immunotherapeutics 2015;11:1147–1152.
  23. Zheng H, Chen Y, Wang F, et al. Comparing live attenuated and inactivated hepatitis A vaccines: an immunogenicity study after one single dose. Vaccine 2011;29(48):9098–9103.
  24. Nelson JC, Bittner RC, Bounds L, et al. Compliance with multiple-dose vaccine schedules among older children, adolescents, and adults: results from a vaccine safety datalink study. Am J Public Health 2009;99(Suppl 2):S389–S397.
  25. Nelson NP, Yankey D, Singleton JA, et al. Hepatitis A vaccination coverage among adolescents (13–17 years) in the United States, 2008–2016. Vaccine 2018;36(12):1650–1659.
  26. Taddio A, Ipp M, Thivakaran S, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine 2012;30:4807–4812.
  27. Leung AK, Chiy AS, Siu TO. Subcutaneous versus intramuscular administration of Haemophilus influenzae type b vaccine. J R Soc Health 1989;109:71–73.
  28. Kayal L, Jayachandran S, Singh K. Idiopathic thrombocytopenic purpura. Contemp Clin Dent 2014;5:410–414.
  29. Makris M, Conlon CP, Watson HG. Immunization of patients with bleeding disorders. Haemophilia 2003;9:541–546.
  30. Kiaersgaard M, Edslev PW, Hasle H. Subcutaneous anti-D treatment of idiopathic thrombocytopenic purpura in children. Pediatr Blood Cancer 2009;53:1315–1317.
  31. Vaccination for people with bleeding disorders. Australian Immunisation Handbook. Available at https://immunisationhandbook.health.gov.au/vaccination-for-special-risk-groups/vaccination-for-people-with-bleeding-disorders#expand-collapse-all-top accessed on 22nd August 2019.
  32. Individuals with bleeding disorders. In the Communicable Disease Control Manual Chapter 2: Immunization Part 2 – Immunization of Special Populations. BC Centre for disease control. January 2009 Available at http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/CD%20Manual/Chapter%202%20-%20Imms/Part2/BleedingDisorders.pdf accessed on 28th August 2019.
  33. Clem AS. Fundamentals of vaccine immunology. J Glob Infect Dis 2011;3:73–78.
  34. Hepatitis A. https://www.who.int/ith/vaccines/hepatitisA/en/accessed on 10th January 2019.
  35. Link-Gelles R, Hofmeister MG, Nelson NP. Use of hepatitis A vaccine for post-exposure prophylaxis in individuals over 40 years of age: A systematic review of published studies and recommendations for vaccine use. Vaccine 2018;36:2745–2750.
  36. Balasubramanian S, Shah A, Pemde HK, et al. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) recommended immunization schedule (2018–19) and update on immunization for children aged 0 through 18 years. Indian Pediatr 2018;55:1066–1074.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.