Ahead of World Hepatitis Day on July 28, the World Health Organization (WHO) stated that less than 10% of those infected with viral hepatitis are aware of this potentially life-threatening condition.
“Millions of people across the world and in the WHO South-East Asia region are infected with viral hepatitis without knowing and without receiving treatment. Both worldwide and in the region, less than one in 10 infected people know their status, while less than 10% of those who do know their status receive appropriate treatment,” said WHO regional director for South-East Asia Poonam Khetrapal Singh.
Dr. Singh said this lack of awareness and treatment leads to progressive liver damage and can cause life-threatening conditions such as fibrosis and liver cancer, resulting in an estimated 4.1 lakh deaths in the region every year.
Monika Jain, senior consultant,Gastroenterology and Hepatology, Sri Balaji Action Medical Institute, said: “India is among the 11 countries that carry nearly 50% of the global burden of chronic hepatitis. In India, viral hepatitis remains a major public health challenge with intermediate to high endemicity of hepatitis B.”
“The hepatitis B virus infection is a big cause of viral hepatitis and 3%-5% of the Indian population is a carrier of hepatitis B infection. The most common route of transmission in India is from mother to child. Other routes of transmission include unsafe blood products, immunological products, sexual contact with an infected person, and unsafe needles and syringes,” said Dr. Jain.
“The most common symptoms of this disease include skin, or the whites of the eyes, turning yellow, fever, fatigue that persists for weeks or months, loss of appetite, nausea, and vomiting. These symptoms should not be ignored,” she said.
Doctors said about 16% of untreated acute hepatitis covers latent or chronic hepatitis B, and the risk is much higher among children.
“Reuse of injections and unsafe injection practices adds to the risk of acquiring both hepatitis B and C in medical settings. Secondary risk factors include tattooing, mother-to-child transmission at birth and unprotected sex. It can also lead to end-stage liver disease, liver cancer and cirrhosis if undetected for a long period. In India, around 40 million people get chronically infected with hepatitis B, while 6 million to 12 million people get chronically infected with hepatitis C,” said Gaurav Jain, senior consultant, Internal Medicine, Dharamshila Narayana Superspeciality Hospital.
Hepatitis B and C virus infections usually cause chronic hepatitis, which leads to liver cirrhosis, liver cancer, and death. Around 40 million people are infected with the hepatitis B virus, and 8.5 million to 12 million with the hepatitis C virus in India. Around 30% of liver cirrhosis cases are due to hepatitis B and 10% to 12% due to hepatitis C virus infection in India.
Nripen Saikia, senior consultant, Gastroenterology and Hepatology, PSRI Hospital, said: “There are multiple viruses that cause acute self-limiting liver injury and some causes chronic liver injury [chronic hepatitis]. Hepatitis A and E virus infections are commonly seen and are transmitted through contaminated water and food. They are usually self-limiting, although sometimes they may lead to severe liver damage.”
The WHO said urgent action is needed to find, test and treat the missing millions suffering from viral hepatitis and to achieve the time-bound targets of WHO’s South-East Asia’s regional action plan.
“That includes ensuring at least 50% of infected people know their status and at least 75% of those diagnosed with the disease are provided treatment by 2020. Also, 90% or more of newborns should receive the birth dose of the hepatitis B vaccine and at least 95% of children should complete the vaccine’s three-dose schedule. Increased injection safety in health facilities is also critical,” added Dr. Singh.
To achieve these outcomes and eliminate viral hepatitis as a public health threat by 2030, as envisaged in the WHO’s global health sector strategy on viral hepatitis, greater awareness among high-risk groups and the general public is key, she said.
The WHO also noted that where individuals test positive for hepatitis B or C, access to effective and affordable treatment is vital. While treatments have existed for hepatitis B for some time, directly-acting antiviral drugs can now cure hepatitis C in up to 95% of cases. Notably, the cost of these treatments has reduced dramatically, while most are now registered and licensed in each of the region’s countries.
To reduce costs further, member states should make full use of flexibilities in global trade agreements, advised the WHO.
Types of hepatitis viruses – A, B, C, D and E
Hepatitis B and C cause chronic liver disease
Hepatitis A and E spread through contaminated water or food. They often produce symptoms such as jaundice but last for short durations
Hepatitis D is an incomplete virus and causes infection only along with hepatitis B
- Loss of appetite accompanied with nausea
- Web of swollen blood vessels in the skin
- Pain on the right side of the belly under the rib cage
- Clay-coloured stool
- Sore muscles
CAUSES AND TRANSMISSION
- Close contact with an infected person
- Sharing food or drinks with an infected person
- Eating contaminated food
- Sexual contact with an infected person
- Faecal-oral route due to faecal contamination of drinking water
- Ingestion of undercooked meat or meat products derived from infected animals
- Transfusion of infected blood products
- Transmission from a pregnant woman to the foetus
- Intravenous drug abuse and tattoos
WHO IS AT RISK OF CHRONIC DISEASE?
The chronic nature of the disease depends upon the age at which a person gets infected.
- Children aged less than 6 years who get infected with hepatitis B virus (HBV) are the most likely to develop chronic infections
- 80%-90% of infants infected during the first year of life develop chronic infections and 30%-50% of children infected before the age of 6 years develop chronic infections
- Less than 5% of otherwise healthy persons who are infected as adults develop chronic infection and 20%-30% of adults who are chronically infected develop cirrhosis and/ or liver cancer
Acute hepatitis due to any virus is usually self-limiting and requires a good diet, bed rest and only symptomatic treatment.
Only acute liver failure in acute viral hepatitis requires urgent hospitalisation, intensive treatment and may be liver transplant. Chronic hepatitis B and C can be treated with antiviral drugs both oral and injectable.
Hepatitis C virus (HCV) is curable now and HBV can be controlled with medication. The vaccine is available for hepatitis A virus and HBV only.
- Maintaining quality standards for public water supplies
- Establishing proper disposal systems for human faeces
- Maintaining hygienic practices such as handwashing with safe water, particularly before handling food
- Avoiding consumption of water and/or ice of unknown purity
- Safe blood transfusion
- Safe Injection
- Testing of donated blood for hepatitis B and C
- Safe sex and promotion of correct and consistent use of condoms
WHO SHOULD BE VACCINATED?
- All children and adolescents younger than 18 years and not previously vaccinated should receive the vaccine if they live in countries where there is low or intermediate endemicity
- People who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations and people interned in prisons
- People who inject drugs
- People with multiple sexual partners
- Healthcare workers and others who may be exposed to blood and blood products through their work
- Travellers who have not completed their hepatitis B vaccination series should be offered the vaccine before leaving for endemic areas
- According to the WHO, viral hepatitis caused 1.34 million deaths in 2015 comparable with TB deaths and exceeding deaths due to HIV
- In India, every 12th person is either HBV or HCV positive.
- Over 90% of people with hepatitis C can be completely cured of the virus within 3-6 months
- Appropriate treatment of hepatitis B and C can prevent development of major life-threatening complications of chronic liver disease — cirrhosis and liver cancer
SOURCE: Arvind Khurana, director & HOD, Department of Gastroenterology, Fortis Hospital, Shalimar Bagh