Viral Hepatitis – The silent challenge for India

A day before World Hepatitis Day (July 28th), designated as such by World health Organization to focus global attention on the looming Hepatitis Epidemic, the National Liver Foundation and its partners held a discussion and media round-table on Viral Hepatitis B & C in India at the India Habitat Center, New Delhi

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Viral Hepatitis is a silent pandemic that is affecting India. It is estimated that 25 million to 40 million Indians carry the Hepatitis B & C viruses (HBV and HCV).

Dr Shiv Sarin, Director, Institute of Liver and Biliary Sciences, New Delhi opened the discussion with a reminder that Hepatitis B & C infections are easily transmitted, particularly in health care settings, but with vaccines for Hepatitis B and treatment for Hepatitis C now available, the opportunity was ripe to take bold steps to control the problem of Hepatitis. He said: “We today have a very effective vaccine to prevent Hepatitis B. Every child should be protected at birth with this vaccine. Similarly, infection control and safe injection practices will ensure that no more transmission on Hepatitis B or C takes place in health care settings. For those with Hepatitis C, new drugs today bring hope for complete cure. We need to make sure that treatment is made accessible to all those who need it.”

Ms Bhavna Visharia, a social activist from Mumbai, was a regular blood donor and organizer of blood donation camps. When it was found during her 17th donation that she had Hepatitis C, her situation changed dramatically. Today, she is healthy. She said: “The system of blood donation can save lives; it should be kept that way. We should ensure that life saving processes like blood donation and getting injections do not create a larger problem like Hepatitis for individuals and the society.”

Speaking in conclusion, Dr Samir Shah, Founder and Hon. General Secretary of National Liver Foundation called attention to the growing numbers of people contracting Hepatitis B & C infections in India: “We need to get a handle on the Hepatitis Epidemic in India. A concerted national Hepatitis Control program needs to be launched at the earliest possible. We call on all state governments and our national leadership to take urgent actions.”

Background:

Viral Hepatitis is a silent pandemic that is affecting India. It is estimated that 25 million to 40 million Indians carry the Hepatitis B & C viruses (HBV and HCV). While these numbers dwarf the HIV epidemic in proportion, it is not a ‘burning issue’ that has caused public alarm or made significant headlines.

Global mortality figures due to infections related to Hepatitis is at par with that of Malaria, HIV and Tuberculosis, i.e. 1.2 million deaths per year. The WHO India Hepatitis fact sheets put the prevalence of Hepatitis B as 4% and that of Hepatitis C as 1.2% in the general population.

While most Indians have been exposed to Hepatitis A in their childhoods that resulted in self-limiting illnesses, HBV and HCV infections can silently affect liver function over a long period of time before signs of the organ’s failure become apparent. HBV and HCV carriers are at the risk of liver failure or cancer, or both.

The decades-long delay between HBV or HCV infection and the expression of chronic liver disease makes it difficult to link these diseases to earlier the infections. It has also been a major impediment in efforts to check the epidemic. Even during the infection’s silent phase, those exposed to the virus can actively transmit it to people around them.

India’s Challenges

  • The current figures the country has on viral hepatitis have been extrapolated from testing carried out in blood banks. Large field studies are required for better epidemiology data at the national and state levels for policymaking and targeted programme implementation.
  • Lack of awareness about the viral infection in the medical community has resulted in poor infection control measures across the healthcare delivery chain.
  • In the absence of cost-effective diagnostics and anti-viral medications for HCV and HBV infections, efforts to treat and check the spread of the chronic disease have been in vain.
  • As an epidemic that has not raised enough public and media attention, policy framing and implementation in this field has suffered.

Elimination of viral hepatitis requires strategic action plans and dedicated resources. A patient-centred approach, engaging political leadership and the media, is vital for policymaking that can effectively ensure:

  • Universal hepatitis vaccination programmes
  • Prevention of transmission of the virus
  • Affordable diagnostics
  • Universal treatment of infection