Dr Subhash Gupta
Even though preventable, viral hepatitis is still the second major infectious disease in the world after TB. Worldwide, 9 out of 10 people infected with viral hepatitis are unaware that they have a serious infection and that it can be fatal if not diagnosed on time and monitored properly. According to the World Health Organisation (WHO), Hepatitis B and C claim 1.4 million lives every year and 9 times more people are infected with hepatitis than HIV. This year’s World Hepatitis Day theme is “Finding the missing million”.
Viral Hepatitis: Types and Complications
Let us see how the hepatitis virus gets transmitted and how to prevent such infections. Hepatitis A and E virus are transmitted by feco-oral transmission through contaminated food or water and it can be prevented by improved sanitation. Where appropriate, Hepatitis A vaccination needs to be incorporated widely in the immunisation schedule as a preventive measure. Although mostly a self-limited illness, Hepatitis A and E infection in a small proportion of patients can have a severe impact and would require urgent admission in the ICU, and even liver transplant in extreme cases.
Hepatitis B and C infection causes chronic liver disease, cirrhosis, and liver cancer. But if diagnosed in time, the infection can easily be cured with antiviral drugs or the disease progression can at least be controlled. Interestingly, the biggest discovery of this decade has been the successful drug therapy for Hepatitis C. The research for the cure of Hepatitis B is ongoing and at the current moment, antiviral drugs can only prevent viral multiplication. However, the focus on hepatitis B is majorly on its prevention which is being carried out through universal vaccination as the vaccine is very effective.
There are various modes of transmission of Hepatitis B such as sexual, direct administration of unscreened blood and percutaneous transmissions through contaminated needles or other equipment which pierces the skin such as tattoo needles. However, one of the major routes of transmission worldwide is vertical, i.e., from mother to child. However, according to WHO, this is less common in nations which have a policy of carrying out screening on pregnant women and vaccinations for newborns. Some countries such as Taiwan have neonatal vaccination program which has almost eliminated Hepatitis B infection among pregnant women in the country, by conducting a routine prenatal screening and vaccinating them. This is likely to prevent infection in the mother as well as the infant.
What is good in such scenario is that all types of viral hepatitis can be either controlled or prevented.
Apart from the vagaries of chronic Hepatitis B and C infection, we need to work on lifestyle measures such as preventing alcohol abuse, minimising obesity, controlling diabetes, and preventing drug-induced liver injury. Hepatocellular cancer goes hand in hand with chronic hepatitis and therefore screening and surveillance has an important role in decreasing morbidity and mortality.
The 290 million people worldwide who are living with viral hepatitis need to be diagnosed and linked to clinicians to prevent disease and death. We need to scale up testing, treatment, and vaccination so that the goal of “hepatitis elimination by 2030” can be achieved. Let us take a pledge on World Hepatitis Day that we will “find the missing million” afflicted with chronic Hepatitis infection and bring them under the ambit of standard medical care.
The writer is Chairman, Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi