Hyderabad: A national health study has found that roughly three out of every four young people in Telugu-speaking states have been exposed to Hepatitis A. This places both Telangana and Andhra Pradesh in the middle ground as India witnesses a dramatic shift in how this liver infection spreads across the country.
Nine out of 10 young Indians nationally have Hepatitis A antibodies
The research by the Indian Council of Medical Research (ICMR), published in The Lancet Regional Health – Southeast Asia, reveals that while nine out of 10 young Indians nationally have Hepatitis A antibodies, the Telugu states present a more moderate picture that reflects the country’s complex epidemiological transition.
Exposure rates in Telangana, Andhra Pradesh
Telangana recorded a 75 per cent exposure rate among people aged 6-30 years, while neighbouring Andhra Pradesh showed slightly higher rates at 77 per cent.
These figures place both states firmly in what health experts call ‘intermediate endemicity’ – a category that suggests changing disease patterns and potential health risks ahead.
The age-wise breakdown reveals a concerning trend: in Telangana, about half of young children aged 6-10 years have been exposed to the virus, rising to seven out of 10 teenagers, and nearly nine out of 10 young adults.
Andhra Pradesh shows a similar pattern, with exposure rates climbing from 54 per cent among young children to 86 per cent among adults.
Fewer children are getting infected early, putting them at risk as adults
“Age-specific seroprevalence curves indicate increasing seroprevalence with age,” noted the study authors, highlighting how fewer children are getting infected early compared to previous generations.
This pattern represents a significant departure from the past, when almost all children in developing regions like the Telugu states would have been exposed by age 10. The delayed exposure now means more teenagers and young adults are at risk of severe illness when they eventually encounter the virus.
“Antibodies are like your body’s security guards that remember past invaders. If you have Hepatitis A antibodies, it means you’ve either had the infection before or likely as a child when symptoms were very mild, or you've been vaccinated, and now you’re immune. The concern is for the one out of four who don’t have these antibodies yet; they’re still vulnerable,” said Hyderabad-based General Physician Dr Velmeti Yugandhar.
National context reveals India’s health transition
The findings from Telugu states mirror a broader national trend that has caught health experts’ attention.
Across India, the study found that three-quarters of young children now reach age 10 without Hepatitis A exposure, compared to earlier decades when virtually all children would have been infected by this age.
“In many developing countries, children catch the infection at a young age, usually without showing symptoms, and develop lifelong immunity. But with better sanitation and cleaner living conditions in some parts of India, fewer children are being exposed early,” explained the research context.
Blood samples from nearly 15,000 people
Nationally, the study tested blood samples from nearly 15,000 people aged 6-30 years across 21 states, making it the largest Hepatitis A survey ever conducted in India. The research utilised samples collected during India’s Covid-19 testing efforts in 2021, providing a unique window into the country’s Hepatitis A landscape.
The contrast across states is striking.
While Uttar Pradesh shows the highest exposure rates at 97 per cent – meaning almost everyone has been infected – Kerala recorded the lowest at just 45 per cent, or fewer than half of young people. The Telugu states sit comfortably in the middle of this spectrum.
Why this matters for Telugu families
Hepatitis A might sound like a distant health concern, but the changing patterns have real implications for families in Telangana and Andhra Pradesh. The virus spreads through contaminated food and water, and while it rarely causes long-term problems, it can make teenagers and adults seriously ill.
“It spreads through the faecal-oral route – which means poor sanitation, unsafe drinking water and contaminated food are the main drivers,” the researchers explained. Unlike other forms of hepatitis, the A strain doesn’t cause chronic disease but can lead to weeks of debilitating illness, particularly dangerous for older children and adults.
Hepatitis A is behind acute liver failure in children and adults
Hospital data from across India shows that Hepatitis A accounts for between one-fifth and two-thirds of acute liver failure cases – a potentially life-threatening condition.
“All the studies highlighted that HAV is one of the most common causes of acute liver failure in both children and adults,” the research team noted.
For Telugu families, this means that young adults who escaped childhood exposure are now at risk of severe illness if they encounter contaminated food or water. The symptoms can be particularly harsh for adults: severe fatigue lasting weeks, nausea, stomach pain and yellowing of the skin and eyes.
“What parents need to understand is that Hepatitis A is no longer just a childhood nuisance in our region; it’s becoming an adult health threat. When a 25-year-old who never got infected as a child eats contaminated street food or drinks unsafe water, they can end up bedridden for a month with severe jaundice, unable to work or study. We’re seeing more young professionals and college students in our hospitals with acute liver inflammation that could have been prevented,” said Dr Yugandhar.
The development paradox
The moderate exposure rates in Telugu states reflect what health experts call a ‘development paradox.’
As sanitation improves and living conditions get better, fewer children get exposed to Hepatitis A early in life when symptoms are mild. Instead, they face the virus later when illness can be severe.
Govt’s plans to introduce Hepatitis A vaccination
This transition puts states like Telangana and Andhra Pradesh in a challenging position. They’ve made progress in improving sanitation and hygiene – reducing childhood exposure – but haven’t yet reached the point where they can prevent adult exposure entirely.
“The findings are important because they come at a time when India is debating whether Hepatitis A vaccination should be made part of the government’s Universal Immunisation Programme (UIP),” the study notes. Currently, the vaccine costs families privately, putting it out of reach for most.
India accounts for one-fifth of all global infections
The stakes are significant.
Globally, Hepatitis A caused 160 million infections and nearly 27,000 deaths in 2021, according to international health data. India alone accounted for one-fifth of all global infections and nearly half of the deaths, making it a hotspot for the disease.
“India alone accounted for one-fifth of global infections and nearly half of the deaths, making it a hotspot for the disease,” the researchers emphasised, highlighting the urgent need for policy action.
WHO recommendation on vaccination debate
The World Health Organisation recommends countries consider Hepatitis A vaccination when they transition from high to intermediate infection levels – exactly where India, including the Telugu states, now finds itself.
“WHO recommends considering the introduction of Hepatitis A vaccination for individuals aged 12 months or older based on the following criteria: transition from high to intermediate endemic level; an increasing trend of acute hepatitis, including severe disease among older children, adolescents or adults; and evidence of cost-effectiveness,” the study authors noted.
Early economic studies suggest vaccination could be cost-effective, particularly in regions with intermediate exposure patterns like the Telugu states. A recent analysis from Kerala, which has even lower exposure rates, found that vaccination programs would save money by preventing severe illness and hospitalisations.
What this means for Telugu states’ health policy
For health officials in Telangana and Andhra Pradesh, the findings suggest several priorities.
First, improved surveillance systems are needed to detect and respond to Hepatitis A outbreaks, particularly in areas where exposure rates remain low.
Second, the data supports considering targeted vaccination programs, especially for adolescents and young adults who may have missed childhood exposure. With three-quarters of the population already immune, vaccination efforts could focus on protecting the remaining quarter who remain vulnerable.
“There is a need for research to address this gap by generating evidence on the burden of symptomatic and severe HAV disease at the national level,” the researchers recommended, calling for better tracking of how many people get sick from Hepatitis A infections.
The study also highlights the need for continued improvements in water and sanitation infrastructure. While better hygiene has reduced childhood exposure, it hasn’t eliminated the virus entirely, leaving gaps where outbreaks can occur.
