In India, viral hepatitis is now recognised as a serious public health problem. It places a huge disease, and social and economic burden on the affected individual, family, as well as the health system. As per latest estimates, 40 million people are chronically infected with hepatitis B and six to 12 million people are chronically infected with hepatitis C.
“HEV is the most important cause of epidemic hepatitis, though HAV is more common among children. Most acute liver failures diagnosed are attributable to HEV,” according to the Global Hepatitis Report 2024 released by the World Health Organization (WHO) recently.
The report contained the latest estimates on the disease burden and the coverage of essential viral hepatitis services from 187 countries across the world. As per the report, the number of lives lost due to viral hepatitis is increasing. The disease is the second leading infectious cause of death globally -- with 1.3 million deaths per year, the same as tuberculosis, a top infectious killer.
In a statement, WHO Director-General Dr Tedros Adhanom Ghebreyesus said, "This report paints a troubling picture: despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated."
The report also noted that in 2022, over 50,000 new hepatitis B cases and 1.4 lakh new hepatitis C cases were reported and these infections killed 1.23 lakh people in India that year.
The most common ways in which the infection spreads is either from mother to child during delivery, during transfusion of blood, during contact with the blood of an infected person, while sharing needles by drug users, etc. Even though one can be vaccinated against hepatitis B, the coverage of such vaccination in India is extremely low, said the report.
In common parlance, hepatitis refers to the inflammation of the liver. Viral hepatitis is an infectious disease caused by the hepatitis viruses A, B, C, D and E. In time, the condition can progress to liver fibrosis (scarring), cirrhosis or liver cancer.
Experts opine that the need of the hour is widespread vaccination for hepatitis B among newborns and those adults who were born before the vaccine was introduced and made a part of the national programme.
Dr Uday Sanglodkar, senior consultant hepatologist, Gleneagles Hospitals, Mumbai, says, "The most important step is to halt the transmission of the infection and this can be done via vaccination which is already available for hepatitis B. But for hepatitis C, there is no vaccination at the moment, we need foolproof screening methods and responsible behaviour. This includes for example, screening of blood before transfusion, screening for dialysis patients, ensuring that there is no chance of infection via blood droplets or infected needles during childbirth, ensuring protected sex, discouraging the use of infected needles, ensuring a mother's delivery and post-delivery etc."
As per the WHO report, 'new data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Of these, 83% were caused by hepatitis B and 17% by hepatitis C. Every day, 3,500 people are dying globally due to hepatitis B and C infections.' It further added that half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. The report also suggested that India is the second highest in hepatitis B and C after China.
In India, the problem, say experts, is that despite having a national viral hepatitis control programme, people have not been utilising the free diagnostics and treatment offered under it. Also, the coverage of diagnosis and treatment of hepatitis B cases in India remains very low, as per the WHO report - only 2.4 per cent of the hepatitis B cases were diagnosed and zero per cent received treatment.
The measures taken up by the Indian government in this regard include the hepatitis B vaccine which is administered concurrently with diphtheria, pertussis and tetanus (DPT) and trivalent oral polio vaccine at 6, 10 and 14 weeks. Hepatitis C can be cured by medications.
As per a research paper published by Abhinav Anand from the department of gastroenterology and Human Nutrition Unit at AIIMS, “HCV elimination in India by 2030 is difficult but possible. Contributions from multiple stakeholders are warranted.” In addition to the government policies and financial allocation for drug availability, testing kits, and operational expenditures, we also require awareness among the common public regarding preventive and treatment options for HCV. Continuing services through the NVHCP (National Viral Hepatitis Control Program (NVHCP) 2018)and teleconsultation‐based regular patient follow‐up are measures that can enable uninterrupted care.
