title: Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease: implications for HAV vaccination.
abstract: BACKGROUND
  Universal vaccination against hepatitis A virus (HAV) has been recommended for children because of the changing epidemiological pattern of HAV. Vaccination has also been advised for patients with chronic liver disease as HAV superinfection in these patients can result in severe or even fatal disease. In India, the indications for HAV vaccination are not clear due to contradictory seroepidemiological data in children and lack of data on HAV seroprevalence in patients with chronic liver disease.
  
  
  METHODS
  Sera were collected from children studying in two government-run schools and from patients with chronic liver disease attending the Liver Clinic at the All India Institute of Medical Sciences (AIIMS). The sera were tested for anti-HAV antibodies. The incidence of HAV-induced acute hepatitis and acute liver failure at AIIMS over the last 10 years was also assessed.
  
  
  RESULTS
  A total of 93.2% (1328/1424) of the school children between 4-18 years of age who were included in the study had anti-HAV antibody in their sera. Eighty percent of the children had antibodies against HAV in their sera by the age of 5 years, whereas all the children above 16 years were positive for anti-HAV antibody. A total of 256 patients with chronic liver disease (94 with cirrhosis of the liver, 160 with chronic hepatitis) were tested for the presence of anti-HAV antibody. Of them, 97.6% (248/254) had anti-HAV antibody in their sera. The annual frequency of HAV-induced acute viral hepatitis and acute liver failure at AIIMS during the last 10 years did not show any change.
  
  
  CONCLUSIONS
  Mass vaccination against HAV is not required in north India because of the presence of protective antibodies against HAV in the majority of the population.
authors.affiliation: Departments of Gastroenterology and Pathology, All India Institute of Medical Sciences New Delhi, India.
authors.forename: Subrat Kumar
authors.initials: SK
authors.lastname: Acharya
authors.forename: Yogeshi
authors.initials: Y
authors.lastname: Batra
authors.forename: Bharati
authors.initials: B
authors.lastname: Bhatkal
authors.forename: Bandana
authors.initials: B
authors.lastname: Ojha
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Kaur
authors.forename: Siddarth
authors.initials: S
authors.lastname: Hazari
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraya
authors.forename: Subat Kumar
authors.initials: SK
authors.lastname: Panda
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006506:Hepatitis A / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D022362:Hepatitis A Vaccines / Q000008:administration & dosage; D006801:Humans; D007194:India / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology / Q000821:virology; D016036:Seroepidemiologic Studies
chemical_list: D022362:Hepatitis A Vaccines