What is viral hepatitis?

There are 5 hepatitis viruses that trigger liver illness in people. Hepatitis A and E are transmitted by way of contaminated meals and water, and lead to weeks-long signs akin to fever, belly ache, jaundice (yellowing of pores and skin), darkish urine, and pale stools.

The WHO report, nonetheless, pertains to the blood-borne hepatitis B (hep B) and hepatitis C (hep C) viruses. Some of those viruses could lead to a short-term infections which resolve on their very own. But others can result in power life-long illness, trigger cirrhosis (everlasting scarring of the liver, making it much less environment friendly), and enhance the danger of liver cancer.

Hep B might be prevented by vaccination, whereas hep C might be cured with medicine. The report doesn’t take into account hepatitis D that may solely infect those that are already contaminated with hep B. It can thus be prevented by vaccinating in opposition to hep B.

What does the report say about India?

India has the world’s second highest prevalence of viral hepatitis circumstances, accounting for over 11% of the worldwide burden, the report discovered.
Globally, of the 254 million individuals residing with hep B in 2022, India accounted for 29 million circumstances, second solely to China (79 million circumstances). Of the 50 million individuals residing with hep C on the earth, India accounted for five.5 million circumstances, simply behind Pakistan’s 8.8 million circumstances. The analysis of viral hepatitis additionally remained abysmally low. According to the report, solely 2.4% hep B circumstances and about 28% hep C circumstances have been identified.

With regard to hep C, the WHO report says that India is one in all 10 nations the place 80% infections are amongst injection drug customers.

This is regardless of there current a nationwide programme that gives free analysis and remedy for hep B and C. Dr S Ok Sarin, vice chancellor of the Institute of Liver and Biliary Disease (ILBS), and one of many individuals behind the nation’s nationwide programme, mentioned that regardless that the programme was launched in 2018, its attain stays restricted. “People have not been utilising the free diagnostics and treatment that is offered,” he mentioned.

What is driving up viral hepatitis circumstances in India?

Viral hepatitis might be transmitted by way of contaminated blood transfusions, or by way of contaminated needles.
Dr Sarin, nonetheless, mentioned that India’s hep B circumstances are pushed up by mother-to-child transmission. “Almost 90% of hep B cases in India are transmitted from mother to child, because most blood banks now provide safe blood, and needle-stick transmission in healthcare workers is limited because almost everyone is vaccinated,” he mentioned.

With regard to hep C, the WHO report says that India is one in all 10 nations the place 80% infections are amongst injection drug customers.

What are the challenges in coping with viral hepatitis?

There are extra challenges to controlling hep B (than C), Dr Sarin mentioned. At least three issues should be ensured. “First, all newborns will have to be fully vaccinated against hep B. Second, adults who have not been immunised should also be given the shot. And all those who are diagnosed with the infection should be put on treatment,” he mentioned.

The hep B vaccine was rolled out for kids in 2007-08, beneath the federal government’s common immunisation programme. But a 2019 research discovered that its protection assorted between 41% and 62%. The 2018 National Viral Hepatitis Control Programme additionally makes provisions for vaccination of individuals at excessive threat of contracting hep B, akin to healthcare employees.

When it involves remedy, Dr Sarin mentioned: “The treatment for hep B is done by specialists according to an international guideline. The problem is that the parameters mentioned in the guideline for initiating treatment exclude seven to eight of the 10 people who are diagnosed with the infection. There is a need to adopt a ‘treat all’ approach just like we have done for HIV — meaning anyone diagnosed with the condition should be offered treatment immediately.” The antiviral remedy for hep B slows the power of the virus to wreck the liver.

With regard to hep C, based on Dr Sarin, simply making medicines accessible is half the battle gained. “The available treatment can cure hep C, and has a good efficacy of 80% to 90%. Unlike hep B, for which medicines have to be taken for life, the treatment for hep C goes on for a shorter duration [12 to 24 weeks],” he defined.

How does India’s response to viral hepatitis examine with that to TB?

Crucially, regardless of the an infection killing virtually as many individuals as TB, it doesn’t obtain almost as a lot consideration. Globally, remedy protection for TB was estimated to be round 70% in 2022, however the protection for hep B and C was solely 3% and 20% respectively.

In India, the numbers of deaths as a result of viral hepatitis aren’t similar to TB, which killed an estimated 3.31 lakh individuals in 2022, however the disparity in remedy protection remained stark. The report discovered that not one of the identified sufferers obtained remedy for hep B, whereas simply 21% obtained remedy for hep C. In comparability, 95% of these identified with TB in India have been placed on remedy.

Shortage of medication will not be the issue. According to the report, India has among the many least expensive medication and diagnostics accessible. For instance, the price of a fast diagnostic check for hep B in India, at $0.09, was the bottom among the many nations that reported the determine. Similarly, the price of a fast diagnostic check for hep C was solely $0.21 in India, once more the bottom amongst nations that reported the determine.

In India, the TDF remedy for hep B can be accessible for decrease than the worldwide benchmark worth of $ 2.40 monthly. Moreover, a 12-week course to remedy hep C, for which the worldwide benchmark worth is $60, is on the market for cheaper in India. In reality, a number of Indian drug makers manufacture generic variations of those medicines.