Doctors at All India Institute of Medical Sciences (AIIMS) warned against rising incidences of Hepatitis across India. The liver is a vital organ that performs over 500 different functions essential to sustain life. Inflammation of the liver is called “hepatitis”.
According to the doctors, the clinical presentation of hepatitis can be acute (of short duration) or chronic (of long duration). Patients with acute hepatitis usually present with jaundice and may have nausea, vomiting, and loss of appetite. Recovery from acute hepatitis usually occurs within 4 to 6 weeks in most cases. If the viral infection persists in the body for more than 6 months, it causes chronic inflammation and can progress to chronic liver disease, cirrhosis and cancer of the liver. Some patients may have a chronic viral infection and liver disease without any symptoms.
Dr Shalimar, professor at Department of Gastroenterology, AIIMS said at a press conference revealed that the hospital is seeing an increase in the number of Hepatitis A cases, with the majority of the patients being children and those in the age group of 18-25
Hepatitis is caused by viral infections, drugs and alcohol. There are 5 main hepatitis viruses which may cause liver disease, namely hepatitis A, B, C, D, and E. Hepatitis A and E cause acute hepatitis. Hepatitis B and hepatitis C viruses cause chronic liver disease and together are the most common cause of liver cirrhosis, liver cancer and viral-hepatitis-related deaths. Hepatitis A and E are transmitted through contaminated water. Whereas, hepatitis B and hepatitis C infections occur through exposure to infected blood, for example, unscreened blood transfusions, mother-to-child transmission during birth and delivery, unsafe sexual practices and injectable drug use.
Hepatitis A and E do not require any specific anti-viral drugs for treatment. Hepatitis B virus treatment includes oral tablets which control the virus replication in the body. Treatment for hepatitis B virus requires long-term treatment. For hepatitis C virus infection, treatment for 3 months with antiviral drugs cures more than 95% of patients. Some patients with liver failure, advanced cirrhosis and cancer of the liver may require liver transplantation.
“Apart from hepatitis viruses, liver can be damaged by multiple factors, including an unhealthy lifestyle, consumption of alcohol, consumption of drugs and autoimmune diseases. Excessive fat in the liver can result from excessive body weight, diabetes or a sedentary lifestyle, and this, if uncorrected, can also contribute to liver damage in the long term. Adopting a healthy lifestyle- avoiding alcohol, a healthy diet, daily exercise and avoiding any potentially liver toxic medicine without doctor’s advice are essential for a healthy liver,” the doctors told the reporters.
World Hepatitis Day is celebrated on 28th July every year in remembrance of Dr Baruch Blumberg, the Nobel Prize-winning scientist who discovered the hepatitis B virus and developed the diagnostic test and vaccine for it. On this occasion, there is a collective global effort to increase awareness and encourage efforts- involving the public, national, and international leaders- to take action against hepatitis.
The theme of World Hepatitis Day 2024 is “It’s Time for Action”; this emphasizes the urgent need to reduce new hepatitis infections globally, decrease viral-hepatitis-related deaths, and hence achieve the goal of global elimination of viral hepatitis by 2030.
According to the World Health Organization (WHO), 10 countries (including India) comprise nearly 66% of the global burden of viral hepatitis B and hepatitis C. Data suggests that 254 million people are living with hepatitis B and 50 million people are living with hepatitis C globally. Despite the high prevalence, only 13% of people with chronic hepatitis B infection have been diagnosed and only about 3% have received antiviral therapy. For hepatitis C infection, only 36% have been diagnosed, and 20% have received curative treatment.
India is one of the countries with the highest burden of viral hepatitis and accounts for approximately 12% of the world’s viral hepatitis cases. In India alone, estimates suggest that 40 million people are chronically infected with hepatitis B and 6 to 12 million people are chronically infected with hepatitis C.
The WHO currently targets the global elimination of viral hepatitis by 2030 to eliminate this disease as a public health threat. By 2030, the WHO aims to achieve a 90% reduction in new chronic hepatitis infections and a 65% reduction in viral hepatitis-related deaths.
In India, the National Viral Hepatitis Control Program is working towards this goal. Under this program, all newborns are vaccinated at birth for hepatitis B, and medicines to treat hepatitis B and C virus are provided free of cost. Blood tests for the detection of hepatitis virus are available at government healthcare facilities, and people with risk factors for hepatitis should get tested. Certain groups are at a high risk of infection- including those who have received blood transfusions, healthcare workers, pregnant women, intravenous drug abusers, family members of hepatitis B virus patients, and men who have sexual intercourse with men.
A study from the Department of Gastroenterology, AIIMS, New Delhi has shown that hepatitis A and E together constitute 30% of cases of acute liver failure, a condition with a high mortality of over 50%. The spread of hepatitis A and E can be largely prevented by ensuring access to safe and clean drinking water. In India, the leading causes of liver cirrhosis are alcohol, viral hepatitis and non-alcoholic fatty liver disease (NAFLD), responsible for approximately 43%, 18% and 14% of cases, respectively.
The proportion of alcohol and NAFLD-related cirrhosis is increasing in India. As per a recent study, the number of cases of liver cancer (hepatocellular carcinoma) occurring due to NAFLD is also increasing.
A recent study suggests that more than one-third (38%) of Indians have a “fatty liver” or “metabolic dysfunction associated steatotic liver disease” {previously called non-alcoholic fatty liver disease (NAFLD)}. This is not only restricted to adults but affects nearly 35% of children as well.
“It is often unrecognised in its early stages since it does not cause any symptoms, but can progress to severe liver disease in some patients. The rise in “fatty liver” or “steatohepatitis” is due to the adoption of Western diets- including an increase in fast food consumption and lack of fruits and vegetables, coupled with an unhealthy sedentary lifestyle. The way to conquer this new epidemic is to adopt a healthier lifestyle and achieve weight loss in obese individuals through an adequate diet, restricting junk and sugary food intake, and exercising regularly,” Dr Pramod Garg, head of the Department of Gastroenterology said during the press conference.
Another recent study reported that alcohol is the most common cause of a severe form of liver injury known as acute on chronic liver failure, which is associated with a very high mortality. The preventive strategy must be adopted at the society and policy level.