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Mahesh

15/04/24 09:56 AM IST

India’s hepatitis burden

In News
  • According to the World Health Organisation’s (WHO’s) Global Hepatitis Report 2024, India has among the highest burdens of viral hepatitis — tied with tuberculosis (TB) as the second largest infectious killer globally — in the world.
About Hepatitis
  • There are five hepatitis viruses that cause liver disease in humans.
  • Hepatitis A and E are transmitted through contaminated food and water, and result in weeks-long symptoms such as fever, abdominal pain, jaundice (yellowing of skin), dark urine, and pale stools.
  • The WHO report, however, pertains to the blood-borne hepatitis B (hep B) and hepatitis C (hep C) viruses. Some of these viruses may result in a short-term infections which resolve on their own.
  • But others can lead to chronic life-long disease, cause cirrhosis (permanent scarring of the liver, making it less efficient), and increase the risk of liver cancer.
  • Hep B can be prevented by vaccination, while hep C can be cured with medication.
  • The report does not consider hepatitis D that can only infect those who are already infected with hep B.
  • It can thus be prevented by vaccinating against hep B.
  • Viral hepatitis can be transmitted through contaminated blood transfusions, or through contaminated needles.
  • Almost 90% of hep B cases in India are transmitted from mother to child, because most blood banks now provide safe blood, and needle-stick transmission in healthcare workers is limited because almost everyone is vaccinated.
Major findings about India
  • India has the world’s second highest prevalence of viral hepatitis cases, accounting for over 11% of the global burden, the report found.
  • Globally, of the 254 million people living with hep B in 2022, India accounted for 29 million cases, second only to China (79 million cases).
  • Of the 50 million people living with hep C in the world, India accounted for 5.5 million cases, just behind Pakistan’s 8.8 million cases.
  • The diagnosis of viral hepatitis also remained abysmally low. According to the report, only 2.4% hep B cases and about 28% hep C cases were diagnosed.
Challenges
  • All newborns will have to be fully vaccinated against hep B.
  • Adults who have not been immunised should also be given the shot. And all those who are diagnosed with the infection should be put on treatment.
  • The hep B vaccine was rolled out for children in 2007-08, under the government’s universal immunisation programme. But a 2019 study found that its coverage varied between 41% and 62%
  • The 2018 National Viral Hepatitis Control Programme also makes provisions for vaccination of people at high risk of contracting hep B, such as healthcare workers.
  • The treatment for hep B is done by specialists according to an international guideline.
  • The problem is that the parameters mentioned in the guideline for initiating treatment exclude seven to eight of the 10 people who are diagnosed with the infection.
  • There is a need to adopt a ‘treat all’ approach just like we have done for HIV — meaning anyone diagnosed with the condition should be offered treatment immediately.
  • The available treatment can cure hep C, and has a good efficacy of 80% to 90%. Unlike hep B, for which medicines have to be taken for life, the treatment for hep C goes on for a shorter duration [12 to 24 weeks].
Govt. Initiatives
  • Globally, treatment coverage for TB was estimated to be around 70% in 2022, but the coverage for hep B and C was only 3% and 20% respectively.
  • In India, the numbers of deaths due to viral hepatitis aren’t comparable to TB, which killed an estimated 3.31 lakh people in 2022, but the disparity in treatment coverage remained stark.
  • The report found that none of the diagnosed patients received treatment for hep B, while just 21% received treatment for hep C. In comparison, 95% of those diagnosed with TB in India were put on therapy.
  • Shortage of drugs is not the problem. According to the report, India has among the cheapest drugs and diagnostics available.
  • For example, the cost of a rapid diagnostic test for hep B in India, at $0.09, was the lowest among the countries that reported the figure.
  • Similarly, the cost of a rapid diagnostic test for hep C was only $0.21 in India, again the lowest among countries that reported the figure.
  • In India, the TDF treatment for hep B is also available for lower than the global benchmark price of $ 2.40 per month.
  • Moreover, a 12-week course to cure hep C, for which the global benchmark price is $60, is available for cheaper in India.
  • In fact, several Indian drug makers manufacture generic versions of these medicines.
Source- Indian Express

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