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Monthly Archives: November 2008

vac1This was an unusual dilemma for me. My second child was due for routine vaccinations & my wife planned to take my first child along. Our pediatrician, incidentally a dear friend, suggested that Hepatitis A vaccine be given to my first born. Wife consulted me & with whatever knowledge of hepatitis A and various vaccination programs, I said no. But my wife & our pediatrician together decided otherwise and the vaccine was given anyway. They somehow tried to justify their stand by saying when it comes to children’s health one should not mind spending, as if I was worried about that! In fact the kind pediatrician, offered to pay for the vaccine! Thanks a lot doc!


This blog is in response to that event. I’m bouncing my thoughts off you, random reader. This has now got nothing to do with my daughter’s bygone vaccination.


Hepatitis A is a viral infection which is transmitted by feco-oral route (Don’t say yeeash!). Fecally contaminated water contains viral particles and when such water is consumed infection occurs. Now there is a difference between Hep A infection & Hepatitis A disease. In a large majority (nearly 90%) of children who ingest Hep A contaminated water the virus enters the system, goes into the liver cells, is recognized by the body immune system and is cleared by the body’s policemen. In the process the child develops permanent immunity against future Hep A infection.


In less than 10%, children exposed to Hep A virus, the virus actually damages the liver cells leading to ‘jaundice’, before the body’s immune system is activated. Eventually immune system wakes up and clears the virus from the body, damaged liver cells heals, thus jaundice goes away. Extremely rarely, liver damage is severe enough to be fatal. Unlike Hepatitis B or C, hep A never causes chronic liver disease.


In adults on the other hand, it is a little different. Nearly 30% of those exposed to Hep A suffer from jaundice. And the illness is clinically little more severe in terms of symptoms and duration in adults than in children. Even in adults fatal liver damage is very very rare.


So it appears that it is better to have Hep A exposure during childhood than later.


In endemic regions like India, water contamination is so rampant that practically everyone is exposed and immune to Hep A before they are 10. On the other hand, in developed world, exposure is rare. So it makes sense for a child in the US to be vaccinated against Hep A.


Early vaccination (my child is 3yrs), prevents natural infection and immunity and if the vaccine acquired immunity wanes in late adulthood, the individual is at risk for developing clinically more serious hepatitis. So WHO does not support routine vaccination in endemic areas where Hep A exposure is universal and natural immunity is lifelong.


Any thoughts on this?


P.S., this kind of argument does not apply to diseases like Diphtheria or measles where the clinical illness is severe as well as life-threatening. What I’m saying is I’m not against vaccinations in general. Only against Hep A vaccination for children in endemic areas