Improved sanitation and hygiene, while beneficial public health achievements, have paradoxically led to a decrease in natural Hepatitis A immunity among children, making timely vaccination increasingly crucial as more children are vulnerable to severe illness when infected later in life. Hepatitis A, a liver infection spread through contaminated food, water, or close contact, often presents with mild or no symptoms in children under six, complicating detection and risking transmission. Pediatricians now emphasize vaccination starting at 12 months, with a second dose around 18-19 months, as a primary defense against this preventable disease, recommending it alongside continued good hygiene practices and parental vigilance for symptoms like fatigue, jaundice, or abdominal pain, especially given the continued risk of outbreaks.

Improved sanitation and hygiene, while beneficial public health achievements, have paradoxically led to a decrease in natural Hepatitis A immunity among children, making timely vaccination increasingly crucial as more children are vulnerable to severe illness when infected later in life. Hepatitis A, a liver infection spread through contaminated food, water, or close contact, often presents with mild or no symptoms in children under six, complicating detection and risking transmission. Pediatricians now emphasize vaccination starting at 12 months, with a second dose around 18-19 months, as a primary defense against this preventable disease, recommending it alongside continued good hygiene practices and parental vigilance for symptoms like fatigue, jaundice, or abdominal pain, especially given the continued risk of outbreaks.

Improved sanitation and hygiene, while beneficial public health achievements, have paradoxically led to a decrease in natural Hepatitis A immunity among children, making timely vaccination increasingly crucial as more children are vulnerable to severe illness when infected later in life. Hepatitis A, a liver infection spread through contaminated food, water, or close contact, often presents with mild or no symptoms in children under six, complicating detection and risking transmission. Pediatricians now emphasize vaccination starting at 12 months, with a second dose around 18-19 months, as a primary defense against this preventable disease, recommending it alongside continued good hygiene practices and parental vigilance for symptoms like fatigue, jaundice, or abdominal pain, especially given the continued risk of outbreaks.

From packing a nutritious lunchbox and encouraging handwashing before every meal to sending children with a bottle of safe drinking water, parents build countless everyday habits to protect their child's health.

Over the years, these improvements in hygiene and sanitation have created an unexpected challenge. As fewer children are naturally exposed to Hepatitis A during early childhood, more are growing up without natural immunity to the virus, making timely prevention more important than ever.

A silent infectious disease that is often overlooked

Hepatitis A is a viral infection that affects the liver. It spreads primarily through ingestion of contaminated food or water, or through close contact with an infected person.

More than 50 per cent of children in the age group of 1–5 years remain vulnerable to Hepatitis A infection. This underscores the importance of timely vaccination during the second year of life, beginning at 12 months of age.  

Infected children under 6 years of age usually don’t experience symptoms, making it difficult for parents or caregivers to know that the child has been infected and risking the spread of the disease. Even when they do, symptoms typically start appearing from two to six weeks post-infection and can include fever, tiredness, pale stools and dark urine.  

Children mostly recover with adequate hydration, nutrition and rest, but in rare cases, the disease can relapse for up to 6 months and may require hospitalisation.

The changing phase of Hepatitis A for children

For decades, many children in India were exposed to Hepatitis A early in life and developed natural immunity, often without severe illness. Today, improved sanitation, safer drinking water and better hygiene present an important public health achievement, but it also means more children are growing up without natural immunity.  

If they contract the virus later in childhood or adolescence, the illness is often more severe. This changing pattern is why paediatricians are increasingly emphasising timely vaccination.

Hepatitis A is preventable.

Vaccination is one of the most effective prevention techniques against Hepatitis A. Paediatricians generally recommend Hepatitis A vaccination beginning at 12 months, with a second dose at 18 to 19 months, targeting the window before school exposure begins.

Awareness is parents’ first line of defence

India's progress in sanitation has transformed the disease landscape of the country. But outbreaks of Hepatitis A still occur in urban and semi-urban India, reminding us that the risk has not disappeared.  

The challenge for today’s parents is not just poor hygiene, but the assumption that cleaner surroundings automatically eliminate the need for protection.

Good hand hygiene and vaccination work best together, not as alternatives, but as complementary layers of protection. Parents should also remain alert to warning signs such as unusual tiredness, loss of appetite, stomach pain or jaundice, particularly if there has been a recent outbreak in the community or a change in their child's school environment.

Understanding this epidemiological change and talking to a paediatrician about Hepatitis A vaccination is the way to keep children safe and healthy.

(The author is a paediatrician & professor of paediatrics, SCB Medical College, Cuttack)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.

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