Hepatitis B control: Neighbours’ pride, India’s envy

The World Health Organisation’s (WHO) announcement last week that Bangladesh, Bhutan, Nepal and Thailand have successfully controlled Hepatitis B is welcome because the disease poses a major health challenge to developing countries and these four countries are the first from our region to make the grade. The disease is considered to be under control when its prevalence is less than 1% among children below five years of age. While the achievement of these countries is commendable, it throws into focus the underperformance of India in fighting the malady. It is estimated that about 40 million people in the country are suffering from Hepatitis B and over 10 million from Hepatitis C. One million people are infected by the virus every year. Over one lakh deaths take place every year from complications like liver cirrhosis caused by Hepatitis B.

The best way to control Hepatitis B is immunisation through a birth dose administered to babies within the first 24 hours of birth, which prevents vertical transmission from the mother to the child. This is important because the chances of mother-to-child transmission are very high and most babies infected at birth become chronic carriers of the disease. But the birth dose coverage was only 60% in 2016, and even with institutional deliveries, it is just over 76%. One reason is the fear that the vaccine may go waste if only one dose from a 10-dose vial is used. There is not enough awareness among health workers that other doses can be kept safe for some weeks for use in other children under certain conditions. The WHO has recommended this and the health workers should be educated on this. It is advisable that everyone gets vaccinated and preventive screening of high-risk groups is very important.

India introduced Hepatitis B vaccine in the Universal Immunisation Programme in 2002 and it was scaled up in 2011. The coverage increased after the introduction of a pentavalent vaccine in 2014-15. But it has to improve further even after its introduction with DPT and oral polio vaccine. Hepatitis is a major threat because the virus would remain undetected in children even for long periods after they are inflected without any symptoms. Most would not know about the infection till they reach adulthood and so it is called the silent killer. Infected persons often face social stigma and discrimination. Every public health challenge has its own problems, and in a big country the problems are bigger. India has to find better ways and means to deal with the Hepatitis B threat, as with other public health challenges. Smaller countries are showing the way.