The global focus is on the prevention of hepatitis B and C. We have a vaccine for the treatment of hepatitis B and a cure for hepatitis C. Eliminating both may be an ambitious goal but it is definitely achievable
Viral hepatitis kills nearly 4,000 people every day and close to 1.5 million people every year worldwide. Globally, one in 12 people are infected with viral hepatitis. There can be millions more with viral hepatitis as it can persist undetected for many years before giving rise to symptoms. It can lead to chronic liver damage, cirrhosis, liver cancer and death.
In the South-East Asia Region of the World Health Organisation, this life threatening disease claims around half a million lives each year — more than malaria, dengue, and HIV/AIDS-related deaths combined. There are 100 million people living with chronic hepatitis B and 30 million people living with chronic hepatitis C. Almost three-quarter of these people are unaware of their infection status. Additionally, many children and adults suffer from hepatitis A. Pregnant women in this region are vulnerable to hepatitis E that is life-threatening during pregnancy.
While hepatitis A and E are transmitted through the faeco-oral route ie, consumption of contaminated food and water, hepatitis B and C are transmitted through contact with infected blood — through unsafe injections, medical procedures, blood transfusion, shaving blades, tattoos, piercing instruments and vertically from an infected pregnant mother to her unborn child.
All forms of hepatitis can cause serious complications — some more than others, depending on the baseline health status of the individual. It is important to be aware of the disease and act early to prevent these infections, disability and deaths. It is important to ensure injection and blood safety, adequate hygiene and proper sanitation, vaccination for hepatitis A and B. One should get tested for hepatitis B and C especially if he/she is vulnerable to the disease, like in high-risk professions that requires frequent blood transfusions, unvaccinated people or those who receive frequent injections etc. While there is no vaccine for hepatitis C yet, early diagnosis and treatment can prevent chronic liver damage, cirrhosis, liver cancer and reduce the risk of death.
Even though this disease has been around for quite some time now, yet policy and programme response has been lukewarm. lack of reliable information on extent of infection, disease, disability and death due to viral hepatitis can be responsible for the relative isolation of this disease.
Also, while compounding the problem, it is known that it may take years before the signs and symptoms of this disease manifests itself, especially for hepatitis B and C. Unlike HIV, hepatitis does not have vocal community voices demanding right to diagnosis and treatment. Treatment choices too have been limited. There have been treatments for chronic hepatitis B infection and now cure is also available for for hepatitis C. Towards the end of 2013, when the US Food and Drug Administration approved the directly acting anti-viral drugs that could cure hepatitis C, it was revolutionary. However, the astronomical price of the drugs dampened the excitement.
Relentless advocacy and concerted action especially on price negotiation have already resulted in reducing the prices by 90 per cent for low-and middle-income countries. Further, reductions with the availability of generics will happen in the not-too-distant future. It will be a revolutionary treatment for hepatitis C and only then, we can dream of eliminating this dreaded disease.
Vaccination is one of the best things to happen for public health. Hepatitis B vaccine is effective. It is a part of the routine immunisation schedule for children in all countries. Additionally, the WHO recommends giving hepatitis B vaccination to all newborns within first 24 hours of birth. This simple and cost-effective strategy will give this country a generation that can be free of hepatitis B. Ideally, all children and adults who have not been vaccinated against hepatitis B should get tested and if not yet infected, should take the three doses of the vaccine. This is especially true for those at higher risk like health care workers, those needing frequent blood transfusions or dialysis. People who frequently inject and men who have sex with men are also at increased risk and should get tested and vaccinated.
The other pillar of prevention is avoiding risks — minimal use of injections, insistance on safety of medical procedures, avoiding tattoos, using safe blood for transfusion. When in doubt, get tested. Be informed, be empowered.
This year’s theme for the World Hepatitis Day on July 28 was ‘Prevent hepatitis. Act now.’ This day was chosen to commemorate the birthday of Nobel laureate Baruch Samuel Blumberg, who discovered the hepatitis B virus and developed the first hepatitis B vaccine. The global focus this year will be on prevention for hepatitis B and C; we have vaccine and treatment for hepatitis B and cure for hepatitis C. Combating hepatitis is one of the indicators for the post-2015 health and development agenda. We can be ambitious and aim to eliminate hepatitis B and C — together, we can do it.
(The writer is regional director, World Health Organisation South-East Asia Region)
