July 26,2024
New Delhi: Viral hepatitis can lead to serious complications such as liver cirrhosis, cancer, and even death. Despite this, it remains a severely neglected public health concern in India
Just recently, I was consulted on the case of a 40-year-old techie diagnosed with cirrhosis of the liver and a large cancerous tumour—a condition that could easily have been prevented with something as simple as early screening and accessible vaccination. With an investment of less than ₹500, these preventive measures could have spared him complications and treatment such as a liver transplant that can cost between ₹20 lakh and ₹40 lakh.
This patient ignored swelling in his legs – a key sign of liver failure – for a little more than a year. But a few days ago, when he developed jaundice, he met his physician. A series of tests led us to the tumour in his liver. He had end-stage liver disease and has been waitlisted for a transplant by our medical team.
The story of this patient is not new. In many cases, I meet patients for the first time when they are in the intensive care unit. Some are wheeled into the ICU in critical condition after taking treatments including herbal concoctions from quacks. There is evidence that shows how mass screening and vaccinations for hepatitis have been able to cut down on hospitalisations and deaths.
World Hepatitis Day is celebrated on July 28 in honour of the birth anniversary of Dr Baruch Blumberg, who discovered the hepatitis B virus in 1967 and developed the vaccine two years later. The day is commemorated by raising awareness about viral hepatitis, a preventable and treatable disease, which causes almost 1.3 million deaths a year worldwide.
Viral hepatitis, encompassing hepatitis A, B, C, D, and E, represents a significant and often overlooked public health issue in India. These diseases, which cause liver inflammation, can lead to severe complications such as liver cirrhosis, liver cancer, and death.
India bears a significant burden of viral hepatitis. According to World Health Organisation (WHO), India accounts for 10 per cent -15 per cent of the global burden of hepatitis B virus infections. Hepatitis C also presents a major health concern, with an estimated 6 million to 12 million people infected. Poor sanitation, lack of awareness, and inadequate healthcare infrastructure exacerbate the problem. In Tamil Nadu, statistics say that there could be close to 1.5 per cent of people with chronic hepatitis B and 0.5 per cent with hepatitis C virus infection.
The govt has launched the National Viral Hepatitis Control Programme (NVHCP) to combat this issue. The programme aims to eliminate hepatitis B and C by 2030 through comprehensive prevention, diagnosis, and treatment strategies. The Tamil Nadu govt has adopted the NVHCP and has been work-ing towards elimination of this dreadful disease, but more needs to be done by the govt and the public sector.
If we must achieve these goals, the govt needs to push aggressively for screening for hepatitis B and C and vaccinations against hepatitis B. In the success seen post-COVID vaccinations, several countries such as the UK have started mass vaccinations for hepatitis. We must ensure people, at least those in the 20-59 age group can get their shots, protecting them against this potentially chronic liver disease. The aim is to prevent infection among middle-aged adults with hepatitis B. With rapid lifestyle change, we are increasingly seeing how the disease is impacting people in their 40s and 50s.
Mass vaccination camps are the only way we can eliminate hepatitis B in the state and across the country. The vaccine has an outstanding record of safety and effectiveness and has been used worldwide since 1982. The vaccine recommended by WHO is 95 per cent effective in preventing chronic infections from developing. Protection lasts 20 years. The disease is usually treatable, but in some cases it becomes chronic.
There are different types of viral hepatitis, each with distinct modes of transmission and health impacts. Hepatitis A is primarily transmitted through the ingestion of contaminated food or water, common in regions with poor sanitation. While typically acute, it does not lead to chronic liver disease; vaccination and improved sanitation are effective preventive measures against it.
Hepatitis B spreads through contact with infected body fluids such as blood and semen. It can manifest as both acute and chronic infections, posing a significant risk for liver cirrhosis and cancer. Vaccination is crucial for prevention, with mother-to-child transmission during childbirth a notable concern in India.
Hepatitis C is mainly transmitted through blood-to-blood contact, often due to unsafe injection practices, unscreened blood transfusions, and sexual contact. It frequently progresses to chronic infection, causing long-term liver issues. While no vaccine exists, antiviral medications can cure more than 95 per cent of cases.
Source: Healthworld