• Adenovirus is a group of viruses that commonly cause cold or flu-like symptoms, fever, sore throat, acute bronchitis, pneumonia, conjunctivitis, acute inflammation of the stomach, diarrhoea, vomiting, nausea and stomach pain.
• Adenovirus is known to spread from one person to another through close contact, coughing, sneezing and even by touching an object containing adenovirus and then further touching the mouth, nose or eyes.
• Type 41 adenovirus is suspected of causing Hepatitis B in children. While there are more than 50 types of adenoviruses, it is type 41 that causes diarrhoea, vomiting and fever along with respiratory problems.
• In a statement, WHO said: “Adenoviruses are common pathogens that usually cause self-limited infections.
• They spread from person-to-person and most commonly cause respiratory illness, but depending on the type, can also cause other illnesses such as gastroenteritis (inflammation of the stomach or intestines), conjunctivitis (pink eye), and cystitis (bladder infection).”
• WHO added, “While there have been case reports of hepatitis in immunocompromised children with adenovirus infection, adenovirus type 41 is not known to be a cause of hepatitis in otherwise healthy children.”

• India launched the National Viral Hepatitis Control Programme (NVHCP) on July 28, 2018, to provide free‐of‐charge, algorithm‐based treatment of chronic viral hepatitis C and B using a decentralized hub‐and‐spoke model.  A major milestone was adoption of immunization for HBV in the national immunization program since 2011 to 2012.
• About 257 million persons are infected with chronic hepatitis B (CHB) globally, resulting in 887,000 deaths annually. More than 90% of the deaths and disability as a result of viral hepatitis can be attributed to CHB and chronic hepatitis C infections.
• The World Health Organization (WHO) approved the strategy to eliminate viral hepatitis as a public health threat by 2030, which requires that new CHB be reduced by 90% and mortality attributable to CHB be reduced by 65%.
• India falls in the intermediate hepatitis B virus (HBV) endemicity group, with a prevalence rate of 2% to 4% in the general population.
• Transmission is believed to mostly occur horizontally during early childhood by close physical contact, although up to 30% of cases are due to vertical transmission.
• India harbors 10% to 15% of the global pool of HBV and has 40 million HBV carriers, of whom 15% to 25% develop cirrhosis and complications leading to health care costs and premature death.
• Of the 26 million infants born each year, 1 million run the lifetime risk for HBV infection.
• Another cause for spread is unsafe injections with reuse of syringes or needles.
• About 16 billion injections are prescribed annually worldwide, and more than half are unsafe.
• India contributes to 25% to 30% of the global load, with a frequency of 2.9 injections per person.
• Causality can be attributed to unsafe injections in 46%, 38%, and 12% of cases in HBV, hepatitis C virus (HCV), and HIV transmission.

Where more prevalence of Hepatitis B is seen around the world?

• The World Health Organization (WHO) estimates that during 2019:
• 296 million people worldwide are living with hepatitis B
• 58 million people worldwide are living with hepatitis C
• 1.5 million people were newly infected with chronic hepatitis B
• 1.5 million people were newly infected with chronic hepatitis C
• Both hepatitis B and hepatitis C can lead to lifelong infection. WHO estimates that 1.1 million deaths occurred in 2019 due to these infections and their effects including liver cancer, cirrhosis, and other conditions caused by chronic viral hepatitis.
• Hepatitis A and hepatitis E infections do not result in chronic infection but can be severe and cause liver damage and death. Outbreaks of these infections occur worldwide, particularly in parts of the world with poor sanitation.
• Hepatitis A is usually a short-term infection and does not become a long-term infection.
• Hepatitis B and hepatitis C can also begin as short-term infections but in some people, the virus remains in the body, and causes chronic, or lifelong, infection.
• There are vaccines to prevent hepatitis A and hepatitis B; however, there is no vaccine for hepatitis C.
• The African Region has the highest number of hepatitis B infections in children and the fewest newborn given the hepatitis B vaccine at birth.
• World Hepatitis Day, observed 28 July, aims to raise global awareness of hepatitis B and hepatitis C and encourage prevention, diagnosis, and treatment.
• It has been led by the World Hepatitis Alliance since 2007 and in May 2010, it received global endorsement from the World Health Organization.
• The virus was not discovered until 1966 when Baruch Blumberg, then working at the National Institutes of Health (NIH), discovered the Australia antigen (later known to be hepatitis B surface antigen, or HBsAg) in the blood of Aboriginal Australian people.
• The largest outbreak of Hepatitis B ever recorded was the infection of up to 330,000 American soldiers during World War II.
• The outbreak has been blamed on a yellow fever vaccine made with contaminated human blood serum, and after receiving the vaccinations about 50,000 soldiers developed jaundice.
• In moderate prevalence areas, which include Eastern Europe, Russia, and Japan, where 2–7% of the population is chronically infected, the disease is predominantly spread among children.
• In high-prevalence areas such as China and South East Asia, transmission during childbirth is most common, although in other areas of high endemicity such as Africa, transmission during childhood is a significant factor.
• The prevalence of chronic HBV infection in areas of high endemicity is at least 8% with 10–15% prevalence in Africa/Far East.
• As of 2010, China has 120 million infected people, followed by India and Indonesia with 40 million and 12 million, respectively.
• According to World Health Organization (WHO), an estimated 600,000 people die every year related to the infection.

Who recently successfully controlled the Hepatitis B in South Asia?

• Recently, Bangladesh, Bhutan, Nepal and Thailand became the first four countries in the World Health Organization’s Southeast Asia region to have successfully controlled Hepatitis B.
• When the disease prevalence is reduced to less than 1% among children less than five years of age the Hepatitis B virus is said to be controlled.
• Hepatitis B infection at a young age turns chronic, causing over 1,00,000 premature deaths annually from liver cirrhosis or liver cancer.
• Despite the introduction of hepatitis B vaccine in the Universal Immunisation Programme in 2002 and scaling-up nationwide in 2011, about one million people in India become chronically infected with the virus every year.
• High prevalence among children aged less than five years has not dropped below 1% due to suboptimal coverage of birth dose in all infants within 24 hours of birth.
• Hepatitis B birth dose, given in the first 24 hours, helps to prevent vertical transmission from mother to child.
• Nearly,70-90% newborns infected and 20-30% carriers are the result of Vertical Transmission of Hepatitis B , in India.
• Although the Health Ministry has approved the birth dose in 2008, its coverage remained low — 45% in 2015 and 60% in 2016 — according to a 2019 Health Ministry report.

• There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea.
• Safe and effective vaccines to protect against hepatitis A and hepatitis B are available.
• The hepatitis A vaccine is used in only a few countries; greater use of the vaccine has the potential to control outbreaks.
• The hepatitis B vaccine is used widely around the world. In 2020, global coverageexternal icon with three doses of hepatitis B vaccine was 83%, and 42% of children received a dose at birth, which is necessary to prevent mother-to-child transmission of this infection.
• Improving rates of vaccination coverage, especially among infants and children, will reduce HBV infection, which could help reduce rates of liver disease and death.
• Even though affordable, safe, and effective treatments can prevent liver disease and liver cancer among people living with hepatitis B and cure those living with hepatitis C, WHO estimated that only 10% of people with hepatitis B and 21% of people with hepatitis C worldwide knew they were infected in 2019.
• Of these, 22% and 62% had received treatment, respectively.
• In 2021, CDC released the Global Immunization Strategic Framework 2021-2030, which provides a roadmap to achieving progress toward a world where everyone is protected from vaccine-preventable diseases (VPDs), such as hepatitis A and hepatitis B.

 Three Goals are core immunization program capacities that CDC seeks to strengthen:

• Prevent VPDs by strengthening immunization services.
• Detect VPDs by supporting and improving disease surveillance systems.
• Respond to and prepare for VPD outbreaks.

Two Goals are cross-cutting capacities:

• Sustain immunization program capacities over time.
• Innovate to increase immunization program impact through research and evaluation.

 Measures needed to control Hepatitis B

• Union Health Ministry’s National Programme for Control of Viral Hepatitis for 2018-19, with a budget of Rs.600 crore for the next three years, hopes to screen the vulnerable population and provide free treatment where needed.
• The National Hepatitis Policy will translate into better surveillance and detection of water and blood-borne hepatitis viral infections in various regions.
• Availability of safe and potable water, early screening, vaccination and prevention of misuse of disposable needles and syringes will help to eliminate treatable viral hepatitis.
• Easy availability of the newly discovered drugs at a reasonable price will help to make India free of viral hepatitis by 2030