Eliminating hepatitis should be next focus area

Hepatitis B virus (HBV) infection remains a global public health challenge that causes significant morbidity and mortality and the burden of disease is especially high in less developed countries. 

More than 350 million people in the world are infected with hepatitis B virus. 

The prevalence of HBV infection in India has been estimated to be 4.7%, which makes India an intermediate prevalence country. 

Hepatitis C virus (HCV) is an important cause of chronic liver disease worldwide. The number of chronically infected persons worldwide is estimated to be around 160 million. 

Out of all forms of hepatitis, Hepatitis B and C are the deadliest in nature. Hepatitis B and C are blood-borne viruses. 

In most infected areas in the country, it is primarily caused by blood transfusions with unscreened blood, surgical procedures that follow unsafe practices and the use of unsterile needles by intravenous drug users or diabetics. 

Viral hepatitis infection is emerging as a major health threat in our country at present. Most of the people are unaware that they are infected with chronic viral hepatitis either HBV or HCV or sometimes both, until it’s too late in form of permanent liver damage leading to liver cirrhosis with progressive liver cell failure, manifesting in form of jaundice, abdominal distension, bleeding tendencies and so on. 

Many undiagnosed people present with primary liver cancer, especially those with chronic hepatitis B infection. 

Hepatitis B being a nuclear virus that integrates with the human DNA after entering the human liver cell, creates much more damage than one exhibits symptoms of. 

With the existing treatments, it may not be possible to cure hepatitis B, however at present effective treatment is available to control further viral proliferation.  This reduces the risk of primary liver cancer formation or progression to end stage liver cirrhosis. However, the best way eradicate Hepatitis B is to prevent it. 

High-risk groups comprise of family members of a HBV infected individual, babies born to HBV positive mothers, IV drug abusers, people with body piercing or tattooing, past history of blood transfusion, on hemodialysis, those who are HIV positive and those with multiple sexual partners. 

Occupational risk groups are health care workers such as doctors, staff nurses or laboratory staff in contact with blood. 

All these high-risk groups should be actively screened followed by vaccination against hepatitis B. The government needs to ensure that hepatitis B vaccination is included mandatorily as part of universal immunization program across the country. 

Women who come for antenatal check up to anganwadi centers should be definitely screened for hepatitis B and C. 

Governments also need to ensure all blood banks compulsorily screen for hepatitis B and C. 

Unlike Hepatitis B, hepatitis C virus is a cytoplasmic virus, meaning it does not integrate with human DNA in liver cell. 

Hence, it can be easily treated if detected early. Previously, the treatment for hepatitis C was mainly weekly interferon injections. 

Unfortunately, the treatment was associated with numerous side effects and the overall success rate for a cure was also very poor then. 

However, with the advent of newer generation directly acting antiviral drugs, hepatitis C treatment has become extremely effective, patient friendly and very reasonable in cost.  

Hepatitis C can easily be eliminated, just like what we have done for small pox/ polio in the recent past. The government needs to run countrywide campaigns and provide free-of cost treatment to those who are diagnosed with chronic Hepatitis C. Dr