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.
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.
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