THE SILENT KILLER: HEPATITIS B

Hepatitis is the inflammation of the liver caused by viruses A, B, C, D or E. Hepatitis B virus (HBV) represents one of the most neglected global pandemics. One-third of the world’s population is infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections. It is estimated that about 370 million people worldwide are chronically infected with hepatitis B, the major cause of liver cancer. Most of those infected have no access to affordable treatment. Many live in fear of discrimination because of public misconceptions. Still others remain unaware they are even infected. And hundreds of millions of young people may still be vulnerable because they have not been vaccinated. Liver cancer and liver disease cases caused by acute and chronic HBV exceed the combined death rate from tuberculosis, HIV/AIDS, and malaria. HBV is transmitted the same way as HIV but the hepatitis B virus is up to 100 times more infectious than HIV. Without access to appropriate medical care or treatment, one in four persons chronically infected with hepatitis B dies prematurely from liver cancer or liver failure caused by the virus.

Hepatitis B is of two types. In the case of acute hepatitis B, the person's immune system may get rid of it within a period of time. However, the patient is capable of transmitting it to other patients. 'Chronic' hepatitis-B may be a warrant to death if liver becomes cancerous and a liver transplant is not done.

HBV poses a serious “silent epidemic” challenge to India. Infected persons are unaware of their chronic carrier status, and continue to infect others for decades and eventually burden the society with loss of productive workforce, and the health care system with expenses of treating liver failures, chronic liver diseases, and cancers. HBV is estimated to have led to 500 million chronically infected persons and one million deaths annually.

The incubation period (the time of exposure to onset of symptoms) is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infections are commonly caused by exposure to infected blood and these body fluids. Infections may also occur as a result of iatrogenic exposures (transfusion/ transplantation/dialysis of infected blood/ blood products or organs/tissues), and use of contaminated injections/equipment. Epidemics due to unsafe injection practices have been well documented in India (hepatitis B carriage is 46%), such as among injecting drug users and healthcare workers caring for infected people. Transmission through unsafe sexual intercourse and transmission from mothers to infants is also well-established. At the community and individual level, certain harmful behavioral practices, such as reusing razor blades and injection syringes, practicing unsafe sex, tattooing and sharing needles by injecting drug users all substantially increase the risk of infections with hepatitis B and C virus.

Despite the magnitude of the problem, no regional or national campaign had been carried out till quite late to educate the public and those at risk about the prevention, transmission, and management of hepatitis B. Blood donors are not aware of the threat that HBV poses, and action by governments and decision makers to prevent and control the disease has been slow.

With the efforts of governments to enhance early detection and appropriate management of HBV, the quality of life of millions of people living with this disease can be improved. Within health facilities, screening of blood and blood products, safe injection practices and clean dental work can significantly reduce the risk of infection from hepatitis B.

Prevention and control can be achieved through safe and effective HBV vaccines. World Health Organization (WHO) recommends routine infant vaccination along with catch-up immunization for adolescents and high risk populations. India introduced universal immunization against hepatitis B in 10 states in the year 2002, and in 2011, scaled up this operation countrywide. Screening and immunization of high-risk groups, such as those with history of exposure, risky practices, and occupational risk, such as health care professionals; specific measures for prevention of mother-to-child transmission and promoting safe blood supply, safe injections and safe sex are other recommended preventive measures.