Dr. Pradeepta Kumar Sethy, Director, Department of Gastroenterology, Medica Superspecialty Hospital.
World Hepatitis Day is held on July 28th every year and is an opportunity for people worldwide to unite in the fight against hepatitis. About 400 million people globally are affected with viral hepatitis which is about 10 times more than the number of people affected with HIV. The total number of deaths each year is estimated to be about 1.4 million. Only 1 in 20 people with hepatitis know of their infection and less than 1% undergo treatment.
Viral hepatitis is also a serious problem in India with a high proportion of liver diseases caused by hepatitis viruses – named as hepatitis viruses A, B, C, D, E and G, respectively. Hepatitis A (HAV) and Hepatitis E (HEV) viruses are responsible for majority of the sporadic and epidemic cases of acute viral hepatitis in India. They are mostly spread through contaminated water and food. The average estimated carrier rate of Hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 36 million carriers.
Blood transfusions constitute the most important route of HBV transmission among adults. Other routes of HBV transmission include intravenous drug use, unsafe therapeutic injections, occupational injuries, transmission during healthcare-related procedures such as surgery, haemo-dialysis, and organ transplantation and to lesser extent by perinatal transmission. The estimated prevalence of Hepatitis C (HCV) infection in India is about 1–1.9% and like HBV, HCV is mostly spread through blood transfusions. HCV genotype 3 is reported as the most common genotype in India, accounting for 54–80% of cases. Apart from acute infections, both HBV and HCV can cause chronic infection in humans of which 30% will develop progressive liver disease culminating in cirrhosis and/or hepatocellular carcinoma (HCC).
Viral hepatitis is treatable and preventable. Provision of safe and clean drinking water and improving sanitary conditions constitute important factors in preventing spread of HAV and HEV. Simple methods like maintaining proper hand hygiene is effective to prevent virus spread. However, the cornerstone in preventing HAV is vaccination. Both inactivated and live attenuated vaccines are licensed and available for use in India. The Indian Academy of Pediatrics recommends two doses of vaccines to be given 6 months apart to children aged 1 year or older. Minor adverse reactions which usually occur include local pain and swelling. Though we do not currently have a vaccination against HEV, different types of HEV vaccines are now under development.
Preventive approaches of HBV infection should include vigilant screening of blood and blood products and routine testing of tissue and organ donors. High-risk group of patients who receive blood transfusions (patients with thalassemia major), intravenous drug users, and health care workers should be regularly screened for infection with HBV. Adequate education and counseling regarding safe injection use, use of barrier contraceptives (e.g. condoms) and safe sexual practices should be provided to high risk groups. Vaccination against HBV forms the preventive pillar for HBV infections. Recombinant DNA-based vaccines are available for use in India at a dosing schedule of 0, 1 and 6 months and are aimed to achieve a protective anti-HBs titre of >10 mIU/ml.
Prevention of HCV infection also involves active screening of high-risk groups and meticulous education and counseling targeting both groups at risk and general population. Newly available directly acting anti-viral agents (DAA) offer extremely effective treatment options for HCV infections. However, no HCV vaccines are currently available for HCV prevention. Vaccines against HCV are now under phase I/II clinical trials.
Viral hepatitis imposes a major healthcare issue in India. While HAV and HEV can be prevented by maintaining adequate hygienic conditions and HAV vaccination, HBV and HCV infection prevention will require active screening and treatment, vaccination and educational counseling to help control viral hepatitis in India.