World Hepatitis Day, on July 28th, is an effort to step up national and international initiatives on viral hepatitis, to encourage actions and engagement by individuals, partners, and the public. This is the need of the hour, to highlight that a person is dying every 30 seconds from hepatitis-related illness, over 6,000 people are newly infected with viral hepatitis each day. About 304 million people were living with chronic hepatitis B and C in 2022; half of these were in the active income group, i.e., 30–54 years, with 12% among children under 18 years of age. In India, hepatitis B and C affect 50 million people, i.e., one in 20 Indians is having this. Every year, 9 million children from India are at risk of getting hepatitis B infection from their mothers without any fault of their own. About 2 lakh Indians every year leave this world due to hepatitis-related illnesses. The sad part is that this can be prevented, treated, and cured if we know it, confront it, care for it, and get vaccinated. Let’s know some facts and act to prevent this deadly disease.
Waterborne Disease: Hepatitis A and E
- Every year, we experience 2-3 outbreaks of jaundice in different cities of India. In the last decade, 35 outbreaks of jaundice happened in 23 cities of India, and every year it’s a challenge.
- Particularly, June to October, i.e., the peak of summer, the change in season, and the arrival of the monsoon, is the peak time for this due to water contamination.
- Often happens in groups, i.e., family members, inmates of school/college hostels, jail, or other crowded places, as all were exposed at the same time.
- Contaminated water, sewage leaks into the water supply, unhygienic street foods, green leafy or uncooked salad contaminated, uncooked meat/liver, pork or meat are often the sources.
- Hepatitis A is the most common cause of jaundice in childhood, and hepatitis E is among adults. But with a lack of vaccination, hepatitis A is causing more severe jaundice nowadays among adults.
- Hepatitis E causes more severe and fatal disease among pregnant women.
- Using boiled water is the simplest and best measure. Clean water, clean hands, and clean food are crucial for the prevention of this.
- Proper hand washing often before food intake, avoiding long nails, or regularly cutting your nails, and proper care of food or water during pregnancy are needed.
- A vaccine is available for hepatitis A, and for E, it’s under research. All children after one year of age are requested to receive 2 doses, 6 months apart. Any adult can take this vaccine, and it provides lifelong immunity.
Hepatitis B and C: The Most Common and Long-Standing Problem
- Hepatitis B and C are more infectious than HIV and are 9 times more prevalent in India. Deaths from hepatitis B are equivalent to those of tuberculosis in our country, but they have not achieved as much public attention. Often being asymptomatic and detected in the advanced stage with liver cancer or cirrhosis, it is a silent killer.
- It’s needed to find those missing millions, and it’s advised to “Get tested, get treated, and get vaccinated.”
- Mother-to-baby transmission during pregnancy is the most common cause, and in a family, if anyone has hepatitis B, it’s always advised to test everyone from their maternal side, i.e., brother/sister, mother, maternal uncle, and aunt. They are the group who are at risk and can be detected and prevented from this deadly disease.
- Globally, even after technology and awareness, more than half of needles/syringes used are still unsafe. India contributes to 25% to 30% of the global load, and it’s advised to practice “single-use syringe,” avoiding glass or steel syringes (banned already).
- Sexual transmission is another common mode. Unprotected or multiple sex partners, male-to-male sex are at high risk. Saliva, semen, or body fluid secretion, unprotected sexual relations increase the transmission risk.
- Tattooing, ear piercing, and intravenous drug abusers need to be alert, avoid, and/or check the needles used.
- Surgery, blood transfusion, or dialysis are common risk factors; ensure hepatitis B and C negative from your doctor. Now with advanced testing, this risk is minimized.
“It’s Time for Action”: What Should We Do?
- Are we aware? Hepatitis B and C are often without symptoms. Only 13% know that they have an infection, and only 3% are on treatment. We need to be aware and get tested, and if negative, get vaccinated. If infected, there is no need to worry as effective medicine can cure it if detected early.
- Have we taken the vaccine? In India, hepatitis vaccination is still less than one-third. It’s high time to understand and ensure vaccination for you, your family, or people around you. It’s cheap, safe, and readily available, and now also free by the government. If your kids have not taken the vaccine or not you, please do it. No age is a bar, and during pregnancy, you can take it too.
- Are we protected against hepatitis? Ensure 3 vaccine doses (0-1-6 months). If you missed a dose, you need to take it again. It’s simple and painless. If the last vaccination was more than 10 years ago, please take a booster dose.
- Do we care for mother and baby? 45% of children aged 12 to 59 months were not vaccinated for HBV as per the National Family Health Survey‐4. Ensure all pregnant women are tested for hepatitis as early as possible. Doctors do it, and you please ensure it. The vaccine should be given to all newborns on the first day of birth.
- Let’s pledge for safe practice for hepatitis prevention. Single-use syringes, no sharing of shaving blades/razors at barber shops, new needles for tattoos, safe and/or protected sex, avoid multiple sex partners.
- Do you know hepatitis care is free? In India, free testing and treatment are available under the National Viral Hepatitis Control Programme (NVHCP). Kindly contact your nearest healthcare facility and avail this benefit.
Hepatitis is preventable, treatable, and curable, provided we detect it early and act timely. The global effort is to eliminate hepatitis by 2030. The effort is already there from the government, and we should join hands to make it a mass drive. Society at large, every individual as an ambassador for family or society around him/her, civil society organizations, celebrities, social influencers, and positive media can make this a reality to see a hepatitis-free world.
The views expressed are the writer’s own)
Dr. Ashok Choudhury
Additional Professor of Hepatology, Institute of Liver and Biliary Sciences, New Delhi
Dr. Bishnupriya Sahoo,
Associate Professor of Pediatrics and Gastroenterology, SGT U
(Images from the net).