Viral hepatitis is a silent killer

Viral hepatitis kills approximately half a million people every year in the 11 member states of WHO’s South-East Asia region.

An estimated 100 million people are currently infected with hepatitis B and 30 million with chronic hepatitis C.

Since these infections can go undetected for years, many people do not know they are infected until much later, when treatment may be too late. India has intermediate to high prevalence (3-4.2 per cent) of hepatitis B and an estimated 100,000 Indians each year die due to hepatitis B-related complications.

India’s estimated prevalence of HCV is about 1 per cent with about 12-13 million HCV (hepatitis C virus) carriers. The burden of disease could soon increase substantially.

There are several different viruses that cause viral hepatitis. The most common cause is infection with one of four viruses — hepatitis A, B, C, or E. Possible symptoms include yellowing of the skin and eyes (known as jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain.

Acute hepatitis infections can take weeks to months to fully subside. Complications of chronic hepatitis, which can be caused by hepatitis B or C infections, include scarring of the liver (known as cirrhosis), liver cancer, and even death. Most of these deaths however, are preventable.

Viral hepatitis B and C are the most common causes of liver cirrhosis and cancer worldwide. They are spread most commonly through contact with contaminated blood. Hepatitis A and E are endemic to South-East Asia, where most people are infected during childhood.

They are spread through the fecal-oral route, most commonly when food or drinking water is contaminated by the fecal matter of an infected person.

Lack of proper sanitation contributes greatly to this problem. In India only 25 per cent of the rural population has access to safe sanitation facilities and 60 per cent of urban areas are covered. Consequently, large outbreaks of hepatitis E and sporadic outbreaks of hepatitis A continue to be reported every year by India.

Putting sanitation ‘on track’; and providing universal safe drinking-water coverage beyond 2015 needs to remain high on India’s development and public health agenda.

At the cornerstone of prevention are vaccines. Though a vaccine against hepatitis A is available, it is not yet widely used in the region. All countries of the region, however, have included hepatitis B vaccines in their immunisation programmes for children. Indonesia and Thailand use the tetravalent form, and other countries use the pentavalent form of the vaccine. An additional dose at birth is administered in Bhutan, the Democratic People’s Republic of Korea, India, Indonesia, Myanmar, Maldives and Thailand. Indian estimates show that coverage is low. This year on May 22, the World Health assembly adopted a resolution to improve the prevention, diagnosis and treatment of viral hepatitis. The resolution highlights the importance of expanding hepatitis A and B vaccination programmes.

There are several challenges to translating this resolution into action. In most countries in the region, surveillance systems for viral hepatitis are inadequate. Preventive measures are not universally implemented.

Treatment for hepatitis is not widely available. While there are new medicines that bring the promise of a cure, such treatments come at a significant cost.

A combination of approaches is essential to make these new hepatitis medications accessible in low-and middle-income countries. Administration of treatment on a larger scale would require an expansion of the role of primary health care and training of primary health care personnel.

Special attention must be paid to the transmission of hepatitis B from mother to fetus during pregnancy, by encouraging mothers to get tested for hepatitis B while pregnant and promoting the hepatitis B vaccine for all newborns at birth. National blood donation systems must develop quality-assured screening of all donated blood, tissues and organs for prevention of hepatitis B and hepatitis C.

Healthcare workers must be counselled on the importance of needle safety and glove use when working with blood products.

Emphasis must be placed on adequate sanitation, to improve food and drinking water safety, and control the spread of hepatitis A and E. National policies need to provide equitable access to the prevention, diagnosis and treatment of viral hepatitis. These strategies must have the support of other sectors, both public and private.

The writer is WHO regional director for South-East Asia

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