Low awareness about hepatitis
The WHO and World Hepatitis Alliance have announced the campaign theme for the World Hepatitis Day on July 28, 2015 focusing on the prevention of viral hepatitis, “Prevent Hepatitis: It’s up to you”.
Viral hepatitis is a group of diseases caused by five distinct hepatitis viruses: A, B, C, D and E, which vary from each other in terms of transmission, disease profile, duration and impact. Transmission routes for spread of hepatitis include exposure to infected blood, unsafe injection practices (a major pathway for the spread of HBV and HCV), consumption of contaminated food and drinking water (a major pathway for the spread of HAV and HEV) and mother to child transmission during pregnancy and delivery.
The prevalence of HBV is 4 per cent and HCV is 1.2 per cent amongst the general population in India. As the infection is asymptomatic, most people are unaware of their infection but untreated chronic HBV and HCV C infection can result in liver cirrhosis and liver cancer.
India has documented low awareness about viral hepatitis in community and amongst populations with high risk behaviour. As hepatitis viruses show great diversity in types, prevalence and modes of transmission, policies and strategies for prevention and control needs to be tailored to the specific national or sub-national context.
In India, to reduce the transmission and burden of HBV, immunisation is key strategy. National policy for vaccination recommends three doses of hepatitis B vaccine, administered concurrently with diphtheria, pertussis and tetanus (DPT) and trivalent oral polio vaccine at 6, 10 and 14 weeks. In addition, a birth dose is recommended for all newborns (within 24 hour of delivery) for all institutional deliveries.
However, Health Management Information System data and coverage monitoring data from the WHO for 2013-14 narrates that the birth dose coverage is only 34 per cent (62 per cent for institutional deliveries) and hepatitis B3 coverage is 71 per cent. Strategies like Mission Indradhanush need to be executed effectively to improve vaccine coverage. There are no current policies for HBV adult vaccination for, hence GoI needs a deliberation on needs for framing such policies.
A reduction in transmission of HBV and HCV in the country is attributed to the Centre’s policy on screening of blood and blood products since 2002, but unsafe injection practices are still prevalent. It must also ensure implementation of national policy of injection safety in hea-lthcare settings and safe injection guidelines released in 2014.
Targeted interventions are required for prevention of HBV and HCV amongst IV drug users. Advocacy is required to incorporate screening and management of HBV and HCV in the ongoing NACP-4 implemented by NACO.
Similarly, the Centre should frame policies for screening of antenatal mothers for HBS antigen and frame policies for management of babies born to mothers infected with HBV, which currently do not exist.
The recently launched Mahatma Gandhi Swacchata Mission, Nirmal Bharat Abhiyan (NBA) and community-led total sanitation programme is an appropriate move in reducing the incidence and prevalence of water-borne HAV and HEV.
India has a case reporting system for acute HAV and HEV through IDSP but not for HBV and HCV. Also, the first alert of outbreaks is largely through media reporting. Hence, there is an urgent need for nationally representative seroprevalence surveys and getting a better picture of the epidemiological situation of hepatitis in India.
Lastly, we should focus on building capacity of clinicians and lab technicians; conduct research for patient monitoring and treatment; and establish models for delivering treatment within the existing health system scenario of viral hepatitis in the country.
(The writer is Additional Profes-sor, Indian Institute of Public He-alth-Gandhinagar, Ahmedabad)