World Hepatitis Day, 28 July: What is India doing?

In a recent report, the World Health Organisation (WHO) issued a statement indicating that India has not done enough to check the spread of hepatitis B. It said that India lacks an initiative along the lines of the polio eradication programme that can launch effective nationwide strategies to eradicate hepatitis. Further, the monitoring of hepatitis vaccination of children is not undertaken uniformly across the country.According to WHO, around 4-6 crore people have hepatitis B in India, and around 1 lakh die annually due to viral hepatitis. As many as 8 out of 10 cases of liver cancer can be attributed to hepatitis B, and overall, it is the second most common cancer causing agent after tobacco. On the other hand, hepatitis C infection is much more common than HIV infection in India. With the World Hepatitis Day about to be observed on 28 July, it is time that this serious condition is given its due in the public health arena, and programmes are initiated to curb its spread.

Classification and Symptoms of Hepatitis

Hepatitis is the collective term used to describe the liver infections caused by a group of viruses belonging to various genotypes. Hepatitis A is a hepatovirus, while hepatitis B belongs to the hepadnavirus genotype. The other types – C, D & E – are RNA viruses that resemble other genotypes. Of these, types A and E are transmitted through contaminated food and water, and cause a less severe infection. Types B, C and D are transmitted through the sexual and blood transfusion routes, and can cause chronic or fatal liver infections.Hepatitis B, the commonest of the sexually transmitted types, initially presents with fever, body ache, loss of appetite and jaundice, although one could be asymptomatic even during acute infection. In a vast majority, the infection subsides within a span of one year. Chronic cases are more likely to occur among children; and in one-fifth of adults with chronic hepatitis B infection, cirrhosis and/or cancer of liver could occur.

Prevention of Hepatitis

As with most viral illness, there is no treatment that can effectively cure the condition. Even the two antiviral antibiotics recommended by WHO – tenofovir and entecavir – only stop the replication of the virus, and treatment with them is usually recommended lifelong. Prevention through vaccination is still the best way to check the spread of hepatitis B, and immunization schedules are drawn right from birth to adulthood. In particular, the following vulnerable groups of population should be covered with active immunization:• All medical and paramedical personnel

• Patients requiring blood transfusion and/or dialysis

• Intravenous drug abusers

• Individuals with multiple sexual partners

• Family members and sexual partners of those with chronic hepatitis B infection

• Travelers to countries which have high endemicity of hepatitis

• Neonates of hepatitis B infected mothers

• Individuals with low immunity

In India this year, the employees of the Mumbai electricity board are being screened for Hepatitis B in collaboration with a multinational pharmaceutical company. Earlier this year, a new drug called sofosbuvir was launched in India, which is said to dramatically improve cure rates of hepatitis C infection. In May this year, the Institute of Liver and Biliary Sciences in Delhi was taken on board by the WHO as a collaborating centre for viral hepatitis and liver disorders. Apart from generating data on the illness, one of the key functions of this alliance is to improve access to the preventive and curative aspects of hepatitis treatment.

In keeping with the theme of hepatitis day this year – ‘Prevention of Viral Hepatitis’ – it is vital that hepatitis detection, awareness and prevention programmes are undertaken at multiple levels of public health care.