Eradicating viral Hepatitis from India - A real challenge
Viral hepatitis continues to be a major public health concern, not only in India but across the world. While half of the World’s population has been exposed to different forms of hepatotropic virus, the spectrum of the disease still varies with respect to the etiological agents in different geographical locations across the globe.
According to the recent data provided by WHO, here is a prevalence of over 29 crore people are living with viral hepatitis and are yet unaware of it. This lack of awareness leaving undiagnosed, many are still continuing to suffer and most of them lose their lives in this unknown fight.
On the occasion of World Hepatitis day 2020, which is themed to – ‘Find the missing millions’ aims to create and raise awareness among the masses. While eradication of this deadly disease is possible by following certain small precautionary measures like the use of vaccination against Hepatitis, avoid the use of infected needles/ syringes, making use of barrier contraception measures while having sex with the infected partner, and avoid blood transmission through the use of used shaving razors and blades.
Hepatitis E (HEV) is the major cause acute sporadic and epidemic hepatitis in India. About 15-30% of the cases is acute hepatitis in India is due to HBV. HCV is an uncommon cause of acute icteric hepatitis but causes most of the post transfusion hepatitis. A total of 315 outbreaks of viral hepatitis have been reported from 2015 to 2019 & 99 outbreaks in 2019 alone by the integrated disease surveillance program of the national center for disease control.
Viral hepatitis is characterized by onset of fever, malaise, anorexia, nausea, vomiting followed by appearance of jaundice. Once the jaundice appears the fever disappears. Though hepatitis is a very common disease, most people confuse it with Jaundice, but both are different and people need to understand it for prevention. Jaundice on one hand is a symptom indicating an underlying disease affecting Liver or the biliary system, whereas Hepatitis is the name of a disease, which means there is inflammation of the Liver Parenchyma due to some cause.
The confirmation of the diagnosis is through liver function test which shows presence of conjugated hyperbilirubinemia & 3-5 times rise in the transaminases. Majority of the patients of acute viral hepatitis recover in 4-6 weeks’ time without any residual consequences. However, in some persons, the disease can progress to severe form of disease which is known as Acute liver failure & carries a high mortality.
Education is the key to eradication
The unfinished challenging task would be to eliminate viral hepatitis from our country. There is a dire need to raise awareness among the masses on the rising issues of viral hepatitis by educating and encouraging people to come forward for the access of hepatitis prevention, testing and treatment services. This would need integrated & holistic approach for educating public & healthcare personnel for identifying persons at risk for viral hepatitis & to ensure appropriate counseling, diagnosis medical management & treatment.
Administration of injection using sterilized needles & syringes should be ensure for Health practices. All healthcare persons across the country should be vaccinated as many of them are unsure of their vaccination status & prone to blood borne infection. Public health measures to improve sanitation & provide safe drinking water are important for preventing HAV & HEV.
Encouraging voluntary blood donation in the blood bank would provide safe blood for donation but as a screening tool, individual donor nucleic acid testing (NAT) detects infection for HIV, HBV & HCV much earlier than serological tests. There is also a need to redefine the HAV vaccination strategies in India because of the changing epidemiology in our country. When HEV vaccination is made available in our country it would facilitate in bringing down the high mortality in pregnant mothers when they develop viral hepatitis in the second/third trimester in pregnancy. Scaling up of infant vaccination has already demonstrated & in fact on global HBV prevalence. There are many unfinished tasks left in prevention & elimination of viral hepatitis in India & the Government of India has already set up nation health program for the eradication of viral hepatitis with an aim to make our country free of viral hepatitis.
