Health Talk | Why Hepatitis B elimination in India needs a harder push

With 254 million people living with chronic HBV globally, including 29.8 million in India, Hepatitis B day emphasises the need for increased awareness and action.

On July 28, the world observed Hepatitis B Day, a crucial event dedicated to raising awareness about hepatitis B, an infection of the liver caused by the hepatitis B virus (HBV). This infection can manifest in two forms: acute (short and severe) or chronic (long-term). The need to observe Hepatitis B Day stems from the importance of generating adequate awareness about the significant harm caused by this virus at the population level, enabling the implementation of necessary measures to eliminate it for good.

Diagnosing hepatitis B requires laboratory confirmation, as it is not possible to differentiate it from hepatitis caused by other viral agents on clinical grounds alone.

Chronic HBV infection can lead to serious complications, including cirrhosis of the liver and liver cancer, which significantly increase the risk of death. According to this year's World Health Organization (WHO) report, 254 million people are living with chronic HBV infection globally, with 29.8 million of them residing in India. The majority of deaths from hepatitis B are due to cirrhosis and liver cancer.

In highly endemic areas, hepatitis B is most commonly transmitted from mother to child at birth or through exposure to infected blood, especially from an infected child to an uninfected child during the first five years of life. Other modes of transmission include needlestick injuries, tattooing, piercing, and exposure to infected blood and body fluids, such as saliva, menstrual, vaginal, and seminal fluids. The virus can also be spread through the reuse of contaminated needles and syringes or sharp objects in healthcare settings, the community, or among persons who inject drugs. Sexual transmission is more prevalent in unvaccinated individuals with multiple sexual partners.

Diagnosing hepatitis B requires laboratory confirmation, as it is not possible to differentiate it from hepatitis caused by other viral agents on clinical grounds alone. Accurate diagnosis can be achieved through blood tests.

India has initiated the National Programme on Surveillance of Viral Hepatitis (NPSVH) at the National Centre for Disease Control (NCDC) to control the growing hepatitis epidemic. Government data indicates that the average prevalence of hepatitis B in India is 3-4%. The country is progressively moving towards the elimination of viral hepatitis B and C, aligning with its global commitment to achieving Sustainable Development Goal 3. This goal aims to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases, and to combat hepatitis, waterborne diseases, and other communicable diseases by 2030.

India is a signatory to the resolution 69.22 endorsed in the WHO Global Health Sector Strategy on Viral Hepatitis 2016-2021, which aims to end viral hepatitis by 2030.

The silver lining in the fight against hepatitis B is that it can be prevented with a safe and effective vaccine. The vaccine is typically administered shortly after birth with boosters given a few weeks later, providing nearly 100% protection against the virus. Although the hepatitis B vaccine is currently part of the national immunization program, the government needs to ensure wider vaccine coverage among children to effectively combat the spread of the virus.

Rhythma Kaul, national editor, health, analyses the impact of the most significant piece of news this week in the health sector