Find the missing millions: India against chronic viral hepatitis

Viral hepatitis is a leading cause of death worldwide (1.46 million deaths, a toll higher than that from HIV, tuberculosis or malaria, and on the increase since 1990).

More than 90 percent of this burden is due to the sequelae of liver infections with the hepatitis B virus (HBV) and hepatitis C virus (HCV). The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis.

However, hepatitis is most often caused by a virus.

Worldwide, mortality attributed to viral hepatitis has increased by 22 percent since 2000 despite decline in deaths caused by other infectious diseases, including HIV, tuberculosis, and malaria. World Health Organisation (WHO) estimates that in 2015, viral hepatitis was responsible for 1.34 million deaths per year2. In 2016, in light of the public health burden of viral hepatitis, and persisting gaps in prevention and response, the World Health Assembly approved WHO's first Global Health Sector Strategy on Viral Hepatitis 2016-2021.

This strategy sets the first global targets for eliminating HBV and HCV infections as public health threats by 2030 (defined as a 90 percent reduction in incidence and a 65 percent reduction in deaths) and establishes indicators to monitor implementation of necessary interventions to reach these goals.

"The challenge in eliminating chronic viral hepatitis is due to the infected person being unaware of their chronic carrier status and to the potential for them to continue to infect others for decades. Eventually the society is burdened with loss of productive workforce, and the health care system with expenses of treating liver failures, chronic liver diseases, and cancers. A large study from India has shown that out of 18,589 people screened, HBV infection was detected in 303 (prevalence 1.63 percent) and HCV infection in 56 (prevalence 0.3 percent)," said Dr. Akash Shukla, Consultant Hepatologist & Liver Transplant Physician, Global Hospital.

Screening and prevention can reduce the rate of new infections, but the number of those already infected would remain high for a generation. Prevention of hepatitis B virus (HBV) transmission from infected mothers to their new-borns is critical to HBV control and eventual eradication.

Mother-to-child perinatal transmission causes the highest chronic carrier rate (>85 percent) with a high rate of subsequent chronic liver disease and hepatocellular carcinoma. This risk is reduced by 90% with HBV vaccine given along with hepatitis B immune globulin (HBIG) starting at birth. In the absence of additional efforts, 19 million hepatitis-related deaths can be anticipated from 2015 to 2030. However, advances in medicine have made it possible prevent deaths.

Further Dr. Ameet Mandot, Consultant Gastroenterologists, Hepatologist & Endoscopist, The Gut Clinic, added, "Access to HCV and HBV therapy begins with screening to identify infected persons, followed by referral to a skilled provider; together, these essential prevention steps are known as the 'HBV care cascade' and the 'HCV cure cascade'. Males contributed to about three-fourths of detected HBV (77%) or HCV (73%) infection. Screening detected a higher overall HBV/HCV infection rate in rural (2.52%) than in urban (1.47%) areas (P