Hepatitis – The silent killer affecting millions in India

Despite being able to cause serious life-threatening health problems, awareness of viral hepatitis remains low. World Hepatitis Day is an opportunity for us to create awareness about the most common cause of viral hepatitis, how it spreads and what asymptomatic carriers can do to protect themselves and others.

Hepatitis – The silent killer affecting millions in India
Based on some regional-level studies, it is estimated that approximately 40 million people in India are chronically infected with Hepatitis B and 6-12 million people with Hepatitis C.

By Dilip Turbadkar and Dr Sandeep Sewlikar

Difficult to diagnose, an infection that often has little to no symptoms and is far more easily transmitted than HIV – viral hepatitis is known to be a silent killer. There are five variants of this virus, namely Hepatitis A, B, C, D & E and all are known to cause liver inflammation. However, the difference in their mode of transmission, severity & prevention is what sets them apart. The condition can be self-limiting or can progress to liver failure, liver fibrosis, cirrhosis or liver cancer.

Hepatitis infection broadly falls into two categories — blood-borne B and C and waterborne A and E. At present, Hepatitis types B & C lead to the most cases of deaths. Estimated by WHO at 354 million people worldwide, the burden of hepatitis B and C is one that is constantly growing.

Hepatitis B and C may develop into a chronic infection. One in three persons affected with viral hepatitis B and C are at risk of developing liver cancer. Patients are also at risk of progressive damage to the liver leading to permanent scarring i.e. liver cirrhosis, a condition that leads to liver failure and can be fatal. Many cases may have mild or no symptoms so it is easy to miss. Hence, most patients are not aware of their infection status.

If you have been diagnosed with chronic hepatitis B, your doctor has probably run several blood tests that show if the infection is harming your liver and identify what stage of infection you are in. Doctors consider all of these results when deciding if you need treatment and how often you should be monitored. HBV DNA test measures the amount of hepatitis B virus DNA (viral load) in the blood of chronically infected patients. By using a Polymerase Chain Reaction (PCR) technique that is highly sophisticated and accurate, a clear picture of the viral load can be formed. 

How is hepatitis B transmitted?

HBV is spread by contact with blood or body fluids of an infected person – the same way as the human immunodeficiency virus (HIV). However, HBV is 50 to 100 times more infectious than HIV. Unsafe blood transfusion, tattoos or dental procedures using unsterilized tools, from mother to baby at birth, unprotected sexual contact, or sharing razors can lead to disease transmission from an infected person to a healthy person.

To safeguard against Transfusion-transmitted infections (TTIs), our government should adopt NAT PCR testing at all blood banks. NAT being a very sensitive technology detects early-stage infectious agents such as HIV/HCV/HBV & occult HBV infections, thus helps maximizing blood safety and the availability of safe blood to patients.

Focus On India

The World Health Organisation (WHO) has recognized viral hepatitis as a serious public health problem in India with over 52 million people infected with chronic hepatitis in the country, as per data released in 2016. A lack of public awareness, unreliable testing methods & an absence of a national epidemiological database all contributes to the current prevalence of Hepatitis in the country. With the absence of proper screening measures to keep the burden in check, the situation will only continue to deteriorate. 

In 2018, India launched its National Viral Hepatitis Control Program (NVHCP), recognizing Viral Hepatitis as a public health problem in India and with a focus to integrate the existing programs towards awareness, prevention and treatment for viral hepatitis. The aim of the program is to achieve countrywide elimination of hepatitis C by 2030, a significant reduction in the burden associated with hepatitis infection and a reduction in the risk, morbidity and mortality due to Hepatitis A and E. Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH) has a model treatment center and state reference laboratory under NVHCP where so far 48,116 individuals have been screened for Hepatitis B and 43,596 individuals were screened for Hepatitis C, so far.

Due to the paucity of data, the exact burden of disease for the country is not established. However, available literature indicates a wide range and suggests that HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in India. It is further reported that HEV accounts for 10-40% of acute hepatitis and 15-45% of acute liver failure.

Based on some regional-level studies, it is estimated that approximately 40 million people in India are chronically infected with Hepatitis B and 6-12 million people with Hepatitis C. Out of these, chronic HBV infection accounts for 40% of Hepatocellular Carcinoma (HCC) and 20-30% cases of cirrhosis in India. Whereas, chronic HCV infection accounts for 12-32% of HCC and 12-20% of cirrhosis. These are only some rough estimations and the absolute number can be quite staggering. Therefore, population screening of viral hepatitis becomes imperative as a part of the disease control program.

Despite being able to cause serious life-threatening health problems, awareness of viral hepatitis remains low. World Hepatitis Day is an opportunity for us to create awareness about the most common cause of viral hepatitis, how it spreads and what asymptomatic carriers can do to protect themselves and others.

(The authors are Professor and Head, Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Head – Medical and Scientific Affairs, Roche Diagnostics India respectively. Views expressed are personal and do not reflect the official position or policy of FinancialExpress.com.)

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