I still remember the day an 18-year-old girl, let us call her Ananya, was admitted under my care. She had developed a fever followed by jaundice. At first, it looked like a routine case of acute viral hepatitis A, the kind we see often in India. But her story did not follow the usual path. She started developing vomiting and feeling a bit dizzy.
Her liver function tests started to worsen, her INR climbed, and then came vomiting and confusion. By the time she reached us, she was in acute liver failure. Acute liver failure due to hepatitis A is rare, affecting fewer than one in a hundred patients. Yet in India, hepatitis A remains a leading cause of acute liver failure in young adults. The risk is higher in adolescents and adults, especially those who present with severe disease or underlying risk factors.
For Ananya, we quickly diagnosed ALF and started plasma exchanges as our institutional practice. I watched her liver shrink and then, almost miraculously, grow back. Each day, her ultrasound showed her liver span improving, a young organ regenerating itself. Her phosphorus levels dropped because the new liver was using up every bit of energy it could to rebuild. We prescribed her chocolates and ice cream to boost her phosphorus, and she laughed each time I told her she had a doctor’s order to eat dessert. Even after her discharge, she would come to clinic waiting to hear me say,
“Have ice cream.”
The story has a historical echo. –
In the 1800s, Carl von Rokitansky described “acute yellow atrophy of the liver,” when livers shrank rapidly and patients collapsed with jaundice and encephalopathy.
In those days, doctors would measure liver span daily with percussion and palpation, watching helplessly as it shrank away. Today, we have better tools, and we can see recovery as well as decline. Ananya’s case showed us the opposite of yellow atrophy: her liver span increasing day by day, proof that life can return where disease had almost taken over.
Two days after Ananya was admitted, her brother walked in with fever and jaundice. He too had hepatitis A, from the same plate of pani puri they had shared. But his illness followed the more common course. He rested, ate well, and recovered in two weeks without any major intervention. One virus, two siblings, and two very different stories. That is the mystery of hepatitis A. Some recover easily, others spiral into acute liver failure.
What saved Ananya was timely recognition, intensive care, and the fact that her liver, like many young livers, still had the power to regenerate. Today, she is back in college, healthy and strong. Her brother jokes that he only got the “mild version” of the infection, but the family will never forget how close they came to losing her.
Why hepatitis A can be dangerous
- Most cases are mild, especially in children, and recover fully with rest and good food.
- In adolescents and adults, the risk of severe hepatitis and acute liver failure is higher.
- Less than 1% progress to acute liver failure, but when it happens, it can be life-threatening.
Why vaccination matters
- Universal hepatitis A vaccination is the best way to prevent both mild hepatitis and rare complications.
- In India, especially in states like Kerala, vaccination protects families from outbreaks linked to contaminated food and water.
- Early recognition of severe cases, along with supportive care, saves lives.
Frequently asked questions (FAQs)
- Can hepatitis A cause liver failure?
Yes. Although rare, hepatitis A is the leading viral cause of acute liver failure in young adults in India. - How do people get hepatitis A?
Through contaminated food and water. Street food like pani puri is a common source. - Who should get vaccinated for hepatitis A in India?
Children above one year, unvaccinated adolescents, adults at risk, and family members of infected patients. In Kerala and across India, vaccination is strongly recommended. - Is hepatitis A vaccine safe?
Yes. The vaccine is safe and effective, providing long-term protection. - What is the difference between hepatitis A in children and adults?
Children usually get mild illness. Adults and adolescents are more likely to develop severe disease or complications. - How is acute liver failure from hepatitis A treated?
Supportive care, plasma exchange, monitoring in intensive care, and sometimes liver transplantation if recovery does not occur. - Can the liver really grow back?
Yes. The liver has a unique capacity to regenerate. In Ananya’s case, her liver span visibly increased day by day as she recovered. - Can siblings or family members also get infected?
Yes. Hepatitis A spreads easily in households if hygiene is not strict. Family screening and vaccination are essential. - Where can I get hepatitis A vaccination in Kochi?
Our liver clinic in Kochi, Kerala provides hepatitis A vaccination, screening, and treatment for liver diseases.
- What is the cost-effectiveness of adult hepatitis A vaccination in India?
A recent study confirms that both live attenuated and inactivated hepatitis A vaccines are cost-saving, especially in Kerala, and effective in adolescents and young adults. Universal vaccination is recommended for children >1 year, adolescents, and at-risk adults because herd immunity is now low in adults. - Has Kerala or Delhi recently experienced hepatitis A outbreaks?
Yes, Kerala has seen over 3,000 cases and 16 deaths by April 2025. Ernakulam, Malappuram, Kozhikode, and Thrissur districts are worst affected. Delhi also saw a recent spike, especially after the monsoon, due to drinking water contamination. - What can I do during a hepatitis A outbreak?
Boil drinking water, avoid street food, wash hands, and seek early vaccination if not immunized. Report cases to health authorities and hospitals providing plasma exchange for severe cases. - Is there any drug for hepatitis A? No specific antiviral drug exists. Treatment for hepatitis A is supportive: rest, hydration, nutrition, and intensive care in severe cases. Prevention is key with vaccination, safe food and water, and hygiene.
- Are Ayurvedic medicines effective for hepatitis A as they do not have side effects? No scientific evidence supports using Ayurvedic medicines to cure, treat, or accelerate recovery from hepatitis A. Current medical evidence shows treatment remains supportive care: rest, hydration, nutrition, and intensive care for severe cases. Evidence-based medical management and hepatitis A vaccination remain the gold standard for hepatitis A prevention and care in India.
- Is there any benefit to using natural supplements such as curcumin or TUDCA for hepatitis A? No proven benefit exists for curcumin, TUDCA, or other natural supplements like milk thistle in treating hepatitis A. These supplements have not been scientifically validated for hepatitis A treatment, prevention, or accelerating recovery. Evidence-based medical care with supportive treatment remains the safe and effective approach. Always consult healthcare providers before using any supplements during hepatitis A illness.
- Can herbal remedies cure hepatitis A? No, herbal remedies cannot cure hepatitis A, and it is self-resolving. There is no scientific evidence that any herbal treatment can cure, treat, or accelerate recovery from hepatitis A infection. Current medical guidelines emphasize evidence-based supportive care as the only proven effective treatment approach. While some herbal products may be marketed as liver remedies, they have not undergone rigorous scientific validation for hepatitis A treatment. Evidence-based medicine and hepatitis A vaccination remain the cornerstone of hepatitis A prevention and management in India.