The year 2030 is etched into human psyche – as the year that ought to report a whole bunch of developmental milestones related to significant issues of human progress. That is why, today, on July 28, observing World Hepatitis Day, there is a renewal of pledges that viral hepatitis must be eliminated by 2030. The Sustainable Development Goal 3.3 states: “End the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.
But then, 2030 is just less than a decade away, and there is much to be done.According to WHO there are 325 million people globally who live with a Hepatitis infection as of today. Viral hepatitis is an inflammation of the liver and can eventually lead to severe liver disease, even cancer. Another one of those “silent” medical conditions, hepatitis is a global health problem, and obviously more of a burden for resource-limited or poor countries. Hepatitis is now equated with the big three of communicable diseases – HIV and AIDS, malaria and tuberculosis.
Put simply, hepatitis is inflammation (swelling) of the liver caused by a group of viruses known as the hepatitis viruses. But hepatitis can also be caused by toxic substances (alcohol, certain drugs, chemicals like industrial solvents), other infections and autoimmune diseases. Jaundice is the most commonly understood and known condition caused by this family of viruses (known as Hepatitis A Virus, B, C, D and E). The infection can be acute (coming on suddenly and retreating in a maximum of a few months) or chronic (long-term and troublesome). The Hepatitis B and C viruses are particularly obstinate and serious, known to cause chronic hepatitis which can lead to grave complications including cirrhosis of liver and hepatocellular carcinoma. In fact, according to the World Health Organisation (WHO), over a million people die each year because of Hepatitis B and C infection.
Hepatitis A: This is the most common type of viral hepatitis, often occurring where sanitation is a problem. The fever that comes with it can be treated, there are no other medicines. There is a vaccine for protection against Hep A.
Hepatitis B: Hepatitis B is caused by the hepatitis B virus, spreading through blood and body fluids like semen and vaginal fluids. Unprotected sex or by sharing needles to inject drugs can cause its spread. Full recovery is possible within a couple of months, but some people can end up battling long-term infection. This is known as chronic hepatitis B. A vaccination is available for hepatitis B, which is recommended for high-risk groups.
Hepatitis C: Hepatitis C is caused by the hepatitis C virus, spreading in the same way as Hep B. It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact. Symptoms are flu-like, so many people mistake their condition or remain unaware of the Hepatitis C infection. Many people fight off the infection and will be free of the virus, but with some it can remain in the body for years. This is known as chronic hepatitis C. There are anti-viral medications available, but do have side effects. Also, there is still no vaccine against hepatitis C.
Alcoholic hepatitis: Excessive alcohol consumption over the long term is a proven risk factor for liver damage, eventually resulting in hepatitis. This type of hepatitis is known as alcoholic hepatitis. There are often no specific symptoms, with the discovery of the condition being made when blood tests are undertaken. Persistent consumption of alcohol despite diagnosis of the condition can lead to cirrhosis and liver failure.
Other types of hepatitis
Hepatitis D: Hepatitis D, caused by the hepatitis D virus, shows up in people who are already infected with hepatitis B.
Hepatitis E: Hepatitis E, caused by the hepatitis E virus, is generally a mild and short-term infection, spread through poor sanitation. Person-to-person transmission is rare.
The Government of India (GoI) is a signatory to the resolution 69.22 endorsed in the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021 at 69th WHA towards ending viral hepatitis by 2030. Acknowledging the need for an integrated approach to tackling Hepatitis, the Government of India launched a new National Viral Hepatitis Control Programme (NVHCP) on World Hepatitis Day in 2018. The concept was to build an integrated approach for prevention and control of viral hepatitis, with a view to provide free of charge screening, diagnosis, treatment & counselling services to all, and specially to people belonging to high-risk groups. The key aim of the government’s programme is to:
1. Combat hepatitis and achieve country wide elimination of Hepatitis C by 2030
2. Achieve significant reduction in the infected population, morbidity and mortality associated with Hepatitis B and C viz. Cirrhosis and Hepato-cellular carcinoma (liver cancer)
3. Reduce the risk, morbidity and mortality due to Hepatitis A and E.
The government plans to achieve this using a few key approaches:
1. Enhance community awareness on hepatitis and lay stress on preventive measures among general population especially high-risk groups and in hotspots.
2. Provide early diagnosis and management of viral hepatitis at all levels of healthcare
3. Develop standard diagnostic and treatment protocols for management of viral hepatitis and its complications.
4. Strengthen the existing infrastructure facilities, build capacities of existing human resource and raise additional human resources, where required, for providing comprehensive services for management of viral hepatitis and its complications in all districts of the country.
5. Develop linkages with the existing National programmes towards awareness, prevention, diagnosis and treatment for viral hepatitis.
6. Develop a web-based “Viral Hepatitis Information and Management System” to maintain a registry of persons affected with viral hepatitis and its sequelae.
According to the World Health Organisation that is observing this year’s Hepatitis Day with the theme Hep Can’t Wait, one person dies of a hepatitis-related issue every 30 seconds, even at this Covid-ridden time in the world. This is why the call to action this year is that Hepatitis needs rapid action.