How to reduce Hepatitis burden

How to reduce Hepatitis burden

World Hepatitis Day

Hepatitis B and C, the most contagious and perilous ones among the five main Hepatitis viruses, could be prevented with a little awareness, following universal precautions and ensuring usage of WHO recommended Re Use Prevention syringes and Sharps Stick Injury prevention (SIP) devices.

Among five types of common Hepatitis virus, types B and C lead to chronic liver disease in hundreds of millions of people. Unlike Hepatitis A and E, which are caused by ingestion of infected food and water, Hepatitis B and C are caused by parenteral contact during birth, by unsafe blood transfusion, by unsafe sexual practices, IV drug use and by using infected syringes.

India is home to more than 40 million Hepatitis B virus carriers and contributes 40% of the HBV burden in the So­uth East Asia region. Lack of awareness around safe blood transfusion and unsafe injection practices such as re-use of syringes and needle stick injuries are two major contributory factors for rising disease burden.

Transfer of Hepatitis B virus from infected mother to her unborn baby is one of the most common ways of spreading the virus at the time of bir­th but recently unsafe blood tra-
nsfusion and injections have become other significant ways of spreading of this disease.

According to WHO, 33% of Hepatitis B infections, 42% of Hepatitis C and 2% of the HIV infections are attributed to unsafe injection practices. Thus, unsafe injections contri­bute more than a third of the transmission of viral hepatitis.

To counter the rising incidence of hepatitis B and C, we need sustained efforts and stringent policies that could address the three major challenges: first, intensifying Hepatitis B vaccination (there is no vaccine for Hepatitis C); second, preventing mother to child transmission during chi­ldbirth (common in Hepatitis B as compared to hepatitis C) and other childhood infection, and the third and the most important in the Indian context, lack of awareness around safe injection practices.

Injection safety includes practices aimed at preventing transmission of infectious diseases from one patient to another, or from a patient to a healthcare provider. Some of the incorrect practices which have resulted in the increase of Hepatitis consist of using the same syringe for more than one patient or using the same medication vial for more than one patient.

There has been epidemics of Hepatitis B & C due to reuse of syringes, the medical litera­ture has also been documenting numerous episodes of Needle Stick Injuries (NSI) where the healthcare worker gets injured accidentally with the needle previously used on the patient.

Injection re-use

Today, only one in 20 people with viral Hepatitis know they have it. And just one in 100 with the disease is being treated. With more than one third getting exposed to unsafe injection practices, it would only be beneficial if the patients enquire from their healthcare providers regarding injection re-use and disposal.

The patient needs to be involved and find out if a new needle, new syringe or a new vial is being used for a particular procedure and what measures are taken by a particular clinic/hospital to prevent the spread of infections.

Today, there are smart syringes available which can contain the opportunities of transmission due to potential unsafe practices. The WHO states that millions of people could be protected from Hepatitis infections if all healthcare programmes switched to syringes that cannot be used more than once. The onus also lies on the medical community to encourage and adopt safe practices.

Sound screening of blood at the blood banks and disposing of syringes used during medical procedures and injection drug at every waste generation point, as per Bio Medical Waste rules 2016, is instrumental in countering the epidemic of hepatitis B and C infections in the country.

Moreover, availability of in-jection equipment in adequate quantities to ensure that there is no re-use is important. A robust infrastructure for waste disposal and safe disposal pra­ctices must be in place. These boxes must then be taken for terminal disposal by an auth­orised bio medical waste collection agency. Taking steps like these will go a long way in prevention of Hepatitis.

(The writer is Head of Department, Gastroenterology, Manipal Hospital, Bengaluru)
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