The alarm bell on hepatitis 

The World Health Organisation (WHO) has pressed the alarm bell on rising viral hepatitis mortality. The “Global Hepatitis Report 2024,”  the first consolidated WHO report on the disease, has highlighted that 3500 people are dying globally every day due to hepatitis B and C infections. The report also claims that India has the world’s second-highest prevalence of viral hepatitis, accounting for 11.6% of the combined hepatitis B and C infections. China tops the chart with the highest burden of 27.5% of the global infections. The WHO estimates that worldwide, 254 million people are living with hepatitis B and 50 million people are living with hepatitis C, while 6,000 people are newly infected with viral hepatitis each day. Other key highlights of the report also present a bleak scenario. The report found that half the burden of chronic hepatitis B and C infection is among people 30–54 years old, and men account for 58% of all cases. An estimated 12% of the burden is among children. The National Action Plan on Viral Hepatitis in India explains that hepatitis B and C are transmitted by unsafe injection practices, through contaminated syringes and needles, infected blood and blood products, sexual transmission, and from infected mother to child. Alarming rise in the number of injected drug users and unsafe practices of sharing syringes put them at high risk of contracting hepatitis B and C infections besides HIV. A chronic hepatitis infection can lead to liver cirrhosis or even cancer. This brings into focus the National Viral Hepatitis Control Programme launched in 2018 with the objective of eliminating hepatitis by 2030. As the window for achieving the target is closing fast, intensified actions are needed to implement the action plan with a state- and region-specific focus. Data from the National Action Plan document shows that approximately 3 billion injections are administered in India alone, out of which an estimated 1.89 billion (62.9%) are unsafe, posing a higher risk for transmission of blood-borne viral infections. It points out that in India, unsafe injections lead to a very high incidence of infections in the magnitude of 260,000 HIV infections (5% of the global burden), 21 million hepatitis B infections (32% of the global burden), and 2 million hepatitis C infections (40% of the global burden). Injection safety, therefore, must remain one of the top priorities in the hepatitis elimination programme. Injection safety has already received a policy push in India with the National AIDS and STD Control Programme (NACO) making compliance with the standard precautions with all blood specimens, including not reusing needles/syringes and ensuring their proper disposal to prevent transmission of HIV, mandatory. The government has also initiated the procurement of auto-disabled and re-use prevention (RUP) syringes by the States and Union Territories (UTs) to enable the prevention of infection. Full transition from disposable syringes to RUP syringes in all states is a crucial preventive measure against hepatitis and other injection-related infections. Vaccinating children with the Hepatitis-B vaccination dose at birth is another key prevention measure. Institutional deliveries are critical to ensuring that the newborn gets the birth-dose Hepatitis-B vaccine. The Birth Dose Vaccination Protocol circulated by the Ministry of Health and Family Welfare to States and Union Territories states that vaccination of the child against hepatitis B, polio, and tuberculosis should be provided soon after the child’s birth and certainly before the mother is discharged from the health facility. It calls for taking particular care of the hepatitis B vaccination and administering it to the baby as soon as possible, certainly within 24 hours of birth, to prevent vertical transmission from the mother to the infant. The risk of acquiring a hepatitis B infection for the baby is as high as 85–90% if the mother already has hepatitis B. The health facility having adequate vaccine doses, syringes, etc. in stock is essential to ensuring that every institutional delivery also ensures a birth dose and subsequent doses of the hepatitis B vaccine. The Electronic Vaccine Intelligence Network (eVIN) system that digitises the entire vaccine stock management, their logistics, and temperature tracking at all levels of vaccine storage—from national to sub-district—rolled out by the central government enables vaccination programme managers to review vaccine stock positions in real time. It is heartening to know that the three states in the northeast region—Assam, Manipur, and Nagaland—are among the 12 states in which an eVIN system has been put in place. Besides stock position, the system also allows real-time monitoring of storage temperature across all cold chain points. Preventing hepatitis infection will significantly reduce morbidity and mortality. The WHO report is a reminder for all stakeholders in India to prioritise throwing the safety net of vaccination over all children and all adults who are in high-risk groups. Building awareness, mass screening, and improved access for diagnosis is of paramount importance to combat viral hepatitis infection and eliminate the public health threat.