Hepatitis services should be maintained during COVID pandemic

Dr Mallika Bhattacharyya

(The writer is an Associate Professor, Department of Gastroenterology, Gauhati Medical College and Hospital)

On this day, when the world is battling a major corona virus pandemic we are poised to commemorate 28th July as the World Hepatitis Day to enhance the awareness of Viral Hepatitis which too is a major public health problem in the world and in India. Viral hepatitis can lead to inflammation of the liver that can lead to a range of health problems like cirrhosis of the liver and liver cancer. There are 5 types of Hepatitis virus, A, B, C, D and E of which Hepatitis B and Hepatitis C are responsible for chronic liver disease and together is responsible for 1.3 million lives lost each year. Thus, even amid the corona pandemic, viral hepatitis continues to claim thousands of lives every day. Although there is no vaccine yet for Hepatitis C virus prevention, tremendous strides have been made in its effective treatment through oral antiviral drugs. Whereas for Hepatitis B infection an effective vaccine exists for prevention but only approximately 42% of the children globally have access to the birth dose of Hepatitis B vaccine. Only about 10% of the people living with Hepatitis B and Hepatitis C infection know their hepatitis status.

This year the theme for World Hepatitis Day is "Hepatitis Free Future" with a strong focus on preventing Hepatitis B among mothers and newborns as maternal to child transmission is one of the major routes of transmission of the Hepatitis B virus. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth. All pregnant women should therefore be tested for Hepatitis B as early as possible during the pregnancy in order to prevent passing the virus to the newborn during delivery. To prevent infection among the newborns, all newborns must be given two shots immediately in the delivery room, the first dose of the hepatitis B vaccine and one dose of the Hepatitis B Immune Globulin (HBIG). This should be followed by 2 additional doses of the Hepatitis B vaccine.

Prevalence of Hepatitis B in pregnant women worldwide is 1.5%-2.5% whereas in India it ranges from 0.2% to 7.7%. Timely testing and treatment of viral hepatitis can prevent development of chronic liver disease, cirrhosis and its complications and liver cancer. Therefore, all high risk individuals including all pregnant women should have access to hepatitis testing, vaccination for prevention and treatment services. Once a pregnant women is positive for Hepatitis B, she should be evaluated thoroughly biochemically and radiologically to look for the status of the liver and the viral load and if treatment is required it can be started in the 3rd trimester of pregnancy to reduce the viral load in the mother which will help to reduce the chances of transmission to the child.

Viral hepatitis has been included as a focus area in the Health Related Goal – Goal 3.3, with world leaders pledging to combat it by 2030. Therefore, even during the COVID pandemic all essential hepatitis services should be maintained such as infant immunization, harm reduction services, awareness programmes and continuous treatment of chronic hepatitis B in order to effectively fulfill the goal.

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