Jaundice & Hepatitis A Virus, Is Hepatitis A Vaccine Effective?

Infective jaundice is an inflammation of the liver caused by the hepatitis viruses. There are Hepatitis A, B, C. D and E viruses which cause Jaundice in children and adults. Hepatitis A virus (HAV) is supposed to be one of the benign kinds amongst all .The hepatitis A virus (HAV) is transmitted primarily via the fecal/oral route either through ingestion of contaminated food and water or through direct contact with an infectious person.

Hepatitis A Virus

Incubation Period of Hepatitis A Virus

The incubation period is usually 14–28 days, but can be up to 50 days. Young children usually have asymptomatic infection, but older children and adults commonly experience symptomatic disease.

Transmission of HAV

The hepatitis A virus causes this type of hepatitis and spreads through contact with an infected person’s stool or vomitus.

Contact can occur by eating food made by an infected person who did not wash his or her hands after using the bathroom.

Drinking contaminated water and food if the person who has carry hepatitis A infection touches the water and food.

Placing a finger or an object in your mouth that came into contact with an infected person’s stool.

Having close personal contact with an infected person, such as through sex or caring for someone who is ill.

Symptoms of HAV

The clinical manifestations of acute HAV infection are:-

Malaise

Fatigue

Anorexia

Vomiting

Abdominal discomfort

Diarrhea

Dark urine

Light-colored bowel movements

Yellow skin. It’s less common in children under age 6.

Yellowing of the white part of your eyes (Sclera)

Pain in the upper right part of your belly

Itchy skin

Loss Appetite 

HAV resolves completely in the vast majority of cases but relapses can occur. Rarely, acute liver failure occurs. The estimated case fatality ratio varies with age from 0.1% among children < 15 years of age, to 0.3% among persons 15–39 years of age, to 2.1% among adults aged ≥ 40 years of age.

In contrast to hepatitis B and C, HAV does not cause chronic liver disease. Endemicity of HAV influences how countries implement hepatitis surveillance. High endemic areas are those in which ≥ 90% of children have been infected by 10 years of age, and include much of sub-Saharan Africa and parts of south Asia.

In low or very low endemicity settings, HAV circulation is low and most children are not infected. Infections and symptomatic disease usually occur either in localized food borne outbreaks or among high-risk groups such as non-immune travelers to endemic countries, men who have sex with men, persons who inject drugs, persons with clotting factor disorders and persons with occupational risk of infection. HAV vaccines are licensed for use in persons ≥ 12 months of age. Efficacy of two doses is > 94%.

Investigations:

Liver Function Test (LFT) is the first investigation when the first sign of Jaundice appears. S.Bilirubin is raised and SGOT and SGPT are markedly increased usually the readings go in thousands.

Urine Test is positive for Bile salts and Bile Pigments.

IgM is positive for HAV.

Ultrasonography of abdomen will show hepatomegaly

Treatment of Hepatitis A Virus

Treatment is symptomatic and supportive. There is no specific treatment of Hepatitis A Virus.

Bed rest

Low fat and High Carbohydrate diet is suggested in acute phace.

Hepatotoxic drugs should be avoided.

No role of antibiotics

Hepatitis A Vaccine 

Hepatitis A vaccine confers immunity against HAV infection by the induction of specific antibiotics against the virus. The vaccine confers immune against HAV virus by inducing antibody titres greater than those obtained after passive immunization with immunoglobulin.

There are two type of Hepatitis A vaccine 

1-Live Attenuated Vaccine 

Hepatitis A vaccine is a freeze-dried, live attenuated vaccine. The vaccine is prepared from the H2 attenuated strain of the Hepatitis A virus. Propagated in human diploid cells through a series of technological process including culture, harvesting, purification, preparation, filling and freeze-drying. 

Live Attenuated hepatitis A Vaccine is recommendation in single dose.

2- Formaldehyde inactivated Vaccine

Hepatitis A virus strain HM175 antigen Formaldehyde inactivated.

Inactivated Hepatitis A vaccine recommendation in two dose with 6 month of interval.  

WHO recommends that vaccination against hepatitis A be integrated into the national immunization schedule for children aged ≥ 1 year if indicated based on incidence of hepatitis A, change in the endemicity from high to intermediate, and cost-effectiveness. Hepatitis A vaccination is not undertaken in high endemicity countries due to near universal immunity from asymptomatic childhood infections.

In transitional endemicity countries, nationwide vaccination might be considered. In low endemicity countries, vaccination is considered for high-risk groups. Surveillance and vaccination against hepatitis A should be part of a comprehensive plan for the prevention and control of viral hepatitis.

Doses of HAV Vaccine

2 doses of hepatitis A is recommended as per IAP schedule first dose at the age of 12 month and the second dose of hepatitis A is recommended after 6 month of first dose.

Catch-up vaccination

Unvaccinated persons through age 18 years should complete a 2-dose series (minimum interval: 6 months).

Persons who previously received 1 dose at age 12 months or older should receive dose 2 at least 6 months after dose 1.

International travel

Persons traveling to or working in countries with high or intermediate endemic hepatitis A

Infants age 611 months: 1 dose before departure; revaccinate with 2 doses, separated by at least 6 months, between age 12–23 months.

Unvaccinated age 12 months or  older: Administer dose 1 as soon as travel is considered.

Hepatitis A vaccine Price in India 

Live Atteuaneted vaccine Price 1600/- to 1800/- Rs 

Inactivated Vaccine Price 1800/- to 2100/- Rs

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