World Hepatitis Day 2019: Hepatitis Has Become One Of The Pressing Public Health Concerns In India

With an estimated 40 million people suffering from chronic Hepatitis B and six to 12 million people infected with Hepatitis C, Hepatitis or inflammation of the liver has become one of the pressing public health concerns in India. Not just that, viral Hepatitis caused by Hepatitis Viruses A, B, C, D and E results in whopping economic and social burden on the affected individuals and their families. According to data recorded by World Health Organisation, around 100 million people are suffering from Hepatitis B and 30 million of them are living with Hepatitis C in South-East Asia.

However, it is observed that there are several others with this condition who are not aware of it and have no access to treatment at all due to which millions continue to suffer. As per the estimates of World Health Organisation (WHO), 300 million people across the world are infected with Hepatitis, yet unaware of it and do not undergo treatment. Themed as 'Find the Missing Millions' on World Hepatitis Day, July 28, this year, WHO gives a clarion call to everyone globally to take action and raise awareness to find the missing millions.

Hepatitis B and C are the most common types of Hepatitis infection found in India. Hence, it is essential to know how contagious these are and the risk factors associated with them. Hepatitis B is quite contagious and it gets transmitted through infected blood and some other body fluids. However, it is essential to know that the virus never spreads through sharing utensils or kissing even though it is found in saliva. It does not pass on through sneezing, coughing, or breastfeeding. For the initial three months after exposure, Hepatitis B remains asymptomatic and it can last for 2 to 12 weeks. During this phase, an infected individual could be contagious even without signs of Hepatitis. The virus can live outside the body for up to a week...

 Dr Mallikarjun Sakpal, Consultant, Hepatology and Liver Transplantation, Aster CMI Hospital, Bangalore says, “Two of the most common strains of Hepatitis infection in India are Hepatitis B and C. Hepatitis B and C typically spreads through the exchange of infected bodily fluids. A person may contract Hepatitis by coming into direct contact with infected blood – this has been commonly observed in drug users who share needles or people who receive tattoos from unhygienic places. Another way the virus commonly travels is through sexual contact with an infected individual. It is also possible for a mother to pass on a Hepatitis infection to her baby through childbirth.  Those who are most likely to unexpectedly contract a Hepatitis infection are healthcare workers, people who have unsafe sex with multiple high-risk partners, or those who frequent places where infected needles or razors are used such as unsafe piercing and tattoo parlours or unhygienic barber shops. Hepatitis is a virus that can drastically take a toll on the liver and therefore individuals whose health has already been impacted with diabetes, kidney disease or chronic liver disease are likely to suffer greater health impacts from a Hepatitis infection. In extreme cases, a Hepatitis infection could even develop into liver cirrhosis or liver cancer. We advise such people to take particular care when travelling to high risk HBV countries.”

 Direct contact with infected blood, transfer from mother to baby during birth, being pricked with a contaminated needle, intimate contact with a person infected with Hepatitis B virus, oral, vaginal and anal sex, using a razor with remnants of infected fluid are the possible methods of contraction of Hepatitis B.  Healthcare workers, men having sex with other men, those who use IV drugs, those with multiple sex partners, those with chronic liver disease and kidney diseases, those with diabetes and above 60 years and those visiting countries with high incidence of HBV infection are at a greater risk of developing Hepatitis B. Its symptoms include fatigue, dark urine, joint and muscle pain, loss of appetite, fever, abdominal discomfort, weakness and yellowing of the whites of the eyes (sclera) and skin jaundice. 

Hepatitis B surface antigen test, Hepatitis B core antigen test, Hepatitis B surface antibody test, liver function tests are some of the tests one needs to conduct for screening Hepatitis B. Once these tests are positive, an individual may be required testing for Hepatitis C or other liver functions and ultrasound of liver.

Dr Sunil Shenvi, Consultant HPB and Muti – organ transplant surgeon, BGS Gleneagles Global Hospital, Bengaluru says, "We broadly see three types of hepatitis in our clinical practice. First type is viral hepatitis which spreads by contaminated water and unhygienic food (Hepatitis A and Hepatitis E). The second type is hepatitis B and hepatitis C which is blood borne (transmission through direct contact with blood and body fluids like unsafe sex, sharing of IV needles by drug abusers and transmission from mother to child). Last one is hepatitis caused due to consuming excessive alcohol, autoimmune disease and excessive fat deposition in the liver.”

Dr Shenvi further states that incidence of Hepatitis A & E is increasing due to unclean water consumption and eating unhygienically prepared food by people who travel frequently. Incidence of Hepatitis B has decreased due to routine vaccination of children. Hepatitis C is still prevalent, since many people are unaware that they have hepatitis C and a few youngsters are still engaged in IV drug abuse. Currently we have medicines which can cure Hepatitis C infection. For hepatitis related to alcohol and  fatty liver, people need to stay away from alcohol and avoid becoming over-weight by exercising regularly.

Like Hepatitis B, Hepatitis C too gets transmitted through contaminated blood and exchange of certain body fluids. Those at risk include people who use needles to take drugs that are illegal, snort cocaine and share straws to inhale drugs, are on dialysis, have more than one partner or sleep with people who have sexually transmitted disease, whose spouse or partner has it, have body piercings and tattoos and was born to a mother with Hepatitis C. 

The symptoms of Hepatitis C appear within two to six months. “Extreme nausea, sore muscles, joint pain, fever, nausea or poor appetite, stomach pain, itchy skin, dark urine, jaundice are certain signs of Hepatitis C. While there is no effective vaccine against Hepatitis C virus as yet, there are ways by which one can avoid getting it. Being careful while dealing with drugs, using condoms while having sex, avoiding share of needles, toothbrushes and razors are some of the healthy ways of keeping Hepatitis C at bay,” says Dr Sakpal.

Hepatitis B and C infections increase the risk of chronic liver disease and may result in liver cirrhosis or liver cancer as well. It is important to know about the conditions, avail for the appropriate treatment and lead a lifestyle that won’t hurt the liver and increase further complications. Eating lots of vegetables in as many colour as possible, including fruits and whole grains in moderate amounts, plant-based proteins, lean proteins like egg whites, nonfat yogurt or milk, beans, nuts, fish and poultry, healthy fats like canola and olive oil and fibre rich foods in diet helps to tackle Hepatitis. It is essential to lessen sodium intake and that of processed foods which are often high in sodium and other additives. On this World Hepatitis Day, let us pledge to get all the stakeholders under one roof, find out those who need diagnosis and overcome the burden of Hepatitis virus.