Viral hepatitis: A global health problem

 Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)

Viral hepatitis, the inflammation of the liver that is caused by Hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV) viruses, affects millions of people worldwide, causing acute and chronic hepatitis. HAV and/or HEV cause acute hepatitis without causing permanent damage to the liver.

The majority of people with acute hepatitis caused by HAV or HEV recover with supportive and symptomatic treatment within a few weeks. However, a very small proportion of people infected with HAV or HEV could die from acute liver failure. Of course, epidemics of HAV or HEV infection can be explosive and cause substantial economic losses. HAV or HEV infection can be prevented by using safe drinking water and proper sanitary measures, as these viruses are predominantly transmitted through contaminated water and food. A safe and effective vaccine is also available to prevent HAV infection. Though infection with HBV or HCV may present as acute hepatitis sometimes, it mostly causes chronic hepatitis. HBV or HCV slowly destroy the liver over time without causing noticeable symptoms, which is why these diseases are also known as ‘silent killers’. If left untreated and unmanaged, they can lead to advanced cirrhosis, primary liver cancer, and liver failure. An estimated 57 percent of liver cirrhosis cases and 60 percent of cases of primary liver cancer in the world result from HBV or HCV infection. HDV can cause infection only in the presence of HBV infection. Chronic hepatitis caused by HBV or HCV infection is a major global health problem.

Approximately 354 million people worldwide are living with either hepatitis B or hepatitis C. About 296 million people worldwide are chronically infected with HBV. About one percent of people living with HBV infection (2.9 million people) are also infected with HIV. India has over 40 million HBV carriers and accounts for approximately 14 percent of the entire pool of HBV carriers in the world. As of today, about 58 million people worldwide are chronically infected with HCV. About 2.3 million of the estimated 36.7 million people living with HIV globally have serological evidence of past or present HCV infection. Every year, about 1.1 million people die worldwide due to complications of HBV and/or HCV infections, and about 3.0 million become newly infected. In fact, HBV or HCV infection is more infectious and kills more people worldwide than HIV or AIDS. Yet, neither a high level of awareness nor the political momentum are seen regarding the prevention, control, and elimination of HBV or HCV infection, as we see in the case of HIV/AIDS. It is high time to create awareness among people globally about HBV or HCV infection, its consequences, and ways to prevent the spread of this dreadful and fatal disease. With better awareness and understanding of how we can prevent HBV or HCV infection, we can eliminate this disease from the world and save 4,000 lives a day.

The risk of HBV or HCV infection can be reduced by avoiding their routes of transmission. Unsafe blood transfusions, unsafe injections, sharing drug injection equipment, contact with blood or bodily fluids—all these can result in HBV or HCV infection. Infection is also transmitted from a mother to a child or through sexual contact. Infection through all these routes of transmission can be prevented through proven and effective interventions.

A safe and effective vaccine can protect one from HBV infection for life. Antiviral medicines can cure more than 95 percent of people with HCV infection, but there is currently no vaccine for HCV prevention. An individual protected against HBV is also protected against HDV. The good news is that chronic hepatitis B can be diagnosed with a simple blood test. For those who test positive, there are treatments available that can help control the virus and prevent further damage to the liver. Those who test negative can be vaccinated against the disease. A pregnant woman who has an HBV infection can pass the virus to her infant without timely intervention. To address the problem of spreading HBV infection from mother to infant, all pregnant women and their mothers should be routinely screened for HBV. If a pregnant woman has an HBV infection, the health care provider should make extra efforts to ensure that her newborn baby gets a timely vaccination to prevent this deadly disease. A complete HBV vaccine series can prevent transmission of the virus in over 90 percent of infants born to infected women. To protect every infant from HBV infection, all babies must get the first shot in the HBV vaccine series before leaving the hospital and complete the vaccine series as recommended. Widespread infant vaccination programmes can dramatically decrease the number of new hepatitis B cases.

Timely testing and treatment of viral hepatitis B and C can save millions of lives worldwide. At present, only 10 percent of people who have chronic HBV infections are diagnosed, and 22 percent of them receive treatment. For HCV infection, 21 percent of people are diagnosed, and 62 percent of those diagnosed receive curative treatment. Due to low coverage of testing, vaccination, and treatment, many people worldwide are still missing out on the care they need. Millions still have not been tested and are unaware that they have hepatitis B or C. Many who may have been diagnosed years ago are not accessing their doctors to monitor how hepatitis B or C is affecting their liver’s health, and many are unaware they could be cured of hepatitis C. It is a matter of concern that out of 354 million people living with HBV and/or HCV globally, upward of 300 million (that’s 9 in 10!) are unaware of their infection, and many are unknowingly passing the viruses to their families and friends. Without finding the undiagnosed cases and linking them to care, millions will continue to suffer, and lives will be lost.

The WHO aims to achieve hepatitis elimination by 2030. To get there, it has called upon countries to reduce new infections of hepatitis B and C by 40 percent, reduce hepatitis-related deaths from liver cirrhosis and cancer by 50 percent, ensure that at least 60 percent of people with the hepatitis B and C virus are diagnosed, and ensure that at least 60 percent of those eligible receive appropriate treatment by 2025. Therefore, there is an urgent need for the expansion of affordable HBV and HCV testing and treatment services to simpler and primary-level care. The WHO has called for simplified service delivery of viral hepatitis services worldwide, bringing hepatitis care closer to communities. On World Hepatitis Day, 2023, with the theme “We’re not waiting,” the WHO calls on all countries to accelerate elimination efforts of viral hepatitis, now bringing HBV and HCV testing and treatment services urgently to the real people who need them.