“This is hepatitis… It’s closer than you think”
– World Hepatitis Day 2012 theme
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| Dr R N Kalra |
The World Hepatitis Day logo is the global symbol for encouraging better awareness, action, and support to prevent and treat viral hepatitis.
This year will be the fourth annual World Hepatitis Day – taking place on July 28, the birthday of Nobel Laureate Professor Blumberg who discovered Hepatitis B. The whole point is to encourage people to find out the facts about Hepatitis B and to help decrease the stigmas attached to the virus.
Hepatitis has been referred to as the ‘silent epidemic. That’s because while some people will have symptoms straight away others could go upto 10 years without knowing anything is wrong.
In Hepatitis B, the infection is transferred through the blood to damage the liver and its ability to carry out essential functions for the body. It can also affect other parts of the body including the immune system, digestive system and the brain. Around 130-170 million people on the planet have it.
Thankfully, drug treatments have been successful: 50 per cent success for genotype 1 and an even better 80 per cent for genotype 2. But there is still no vaccine and it’s important that people are more in the know about exactly how dangerous hepatitis is and what it does.
WHO World Hepatitis Day is marked to increase awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as: strengthening prevention, screening and control of viral hepatitis and its related diseases; increasing Hepatitis B vaccine coverage and integrating it into national immunisation programmes; and coordinating a global response to hepatitis.
These viruses constitute a major global health risk with around 350 million people being chronically infected with Hepatitis B
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| World Hepatitis Day Logo |
World Hepatitis Day, observed on July 28 every year, aims to raise global awareness of Hepatitis B and encourage prevention, diagnosis and treatment. World Hepatitis Day was launched by the World Hepatitis Alliance in 2008 in response to the concern that chronic viral hepatitis did not have the level of awareness, nor the political momentum, seen with other communicable diseases such as HIV/ AIDS, tuberculosis (TB) and malaria. This is despite the fact that the number of people chronically infected with, and the number of deaths caused by, Hepatitis B and C is on the same scale as these conditions. World Hepatitis Day has generated massive public and media interest, as well as support from governments.
Approximately 500 million people worldwide are living with either Hepatitis B or C. This represents 1 in 12 people, and this was the basis for the 2008 World Hepatitis Day’s ‘Am I Number 12?’ campaign. If left untreated and unmanaged, Hepatitis B or C can lead to advanced liver scarring (cirrhosis) and other complications, including liver cancer or liver failure. While many people worry more about contracting AIDS than Hepatitis, the reality is that every year 1.5 million people worldwide die from either Hepatitis B or C, faster than they would have from HIV/ AIDS.
Hepatitis B is caused by the Hepatitis B virus (HBV). Most people who get hepatitis B can get rid of the virus on their own; however, unlike Hepatitis A, which eventually goes away, some people with Hepatitis B develop a lifelong infection known as chronic Hepatitis B. This may lead to a scarring of the liver (cirrhosis), liver failure, and can also lead to liver cancer.
The Hepatitis B virus is spread through contact with infected bodily fluids. Among the bodily fluids that can transmit the virus are infected blood and blood products. It is also spread through contact with other infected bodily fluids, such as semen, vaginal fluids, or saliva.
Symptoms
Symptoms can vary, although a number of people will not have any symptoms until significant liver damage has occurred. Treatment for acute Hepatitis B is focussed on dealing with any symptoms or complications that may occur as a result of the infection. This is known as supportive care. Even without specialised treatment for acute hepatitis B, most people recover completely within a few months. For people with chronic Hepatitis B, specific medicines are available to help slow down liver damage.
Cure for Hepatitis B
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| Hepatitis B virus |
The best Hepatitis B “cure” is preventing infection in the first place. Among the ways you can prevent the disease are by getting vaccinated and avoiding high-risk situations (such as unprotected sex and coming into contact with infected blood). However, if infection with the Hepatitis B virus has already occurred, the only cure for the condition is time — eventually, the body is usually able to effectively kill the virus.
Treatment
There are two types of Hepatitis B — acute (recently acquired) Hepatitis B and chronic (lifelong) Hepatitis B. Treatment differs for each type.
For acute hepatitis B, there are no specific medicines that can cure the disease . Therefore, treatment is focussed on dealing with any symptoms or complications that may occur. This is known as supportive care. Even without specialised treatment for acute hepatitis B, however, most people recover completely within a few months
Indian scenerio
An average estimated carrier rate of Hepatitis B virus (HBV) in India is four per cent with a total pool of approximately 36 million carriers among the 400 million Hepatitis B surface antigen carriers worldwide.
Therefore India alone constitutes nine per cent of the total. Wide variations in social, economic and health factors of different regions may explain variations in carrier rates from one part of the country to another. Professional blood donors constitute the major high-risk group for HBV infection in India, with a hepatitis surface antigen B positivity rate of 14 per cent. Blood transfusions represent the most important route of HBV transmission among adults. However, most of India’s carrier pool is established in early childhood, predominantly by horizontal spread due to crowded living conditions and poor hygiene. HBV is reported to be responsible for 70 per cent of chronic hepatitis cases and 80 per cent of cirrhosis of liver cases. About 60 per cent of those cases with hepatocellular carcinoma are HBV marker positive.
Most authorities believe that India falls in the intermediate zone of HBV prevalence i.e., prevalence between two per cent and seven per cent. This figure is based on studies contributed mainly by blood bank screening programmes and screening of healthy pregnant women attending antenatal clinics.
Universal immunisation is usually recommended for any disease that causes significant morbidity; both in terms of numbers as well as in terms of the severity of the consequences of the infection including mortality, provided a safe and effective vaccine is available. Hepatitis B is believed to satisfy both these criteria with an estimated prevalence in India between three per cent to seven per cent and its sequelae of chronic hepatitis, cirrhosis and hepatic carcinoma. The goal of immunisation programme against Hepatitis B is to reduce the incidence of, and possibly eliminate hepatocellular carcinoma and chronic liver disease, by reducing the number of HBV carriers in the population.
World Hepatitis Day has been led by the World Hepatitis Alliance since 2007 and on May 2010, it got global endorsement from the World Health Organization as one of only four mandated health awareness programmes that increased understanding among the general public. The theme aims to encouraging patients to speak out about their own experiences and to play a role in educating and supporting others (‘This is hepatitis…’); challenging individuals to become better aware and involved in tackling hepatitis (‘Know it. Confront it’); reinforcing the prevalence and global impact of hepatitis and reducing the stigma associated with these diseases (‘Hepatitis affects everyone, everywhere’). The World Hepatitis Alliance had developed several campaign materials to support local organisations in their communications around the 2011 theme.
Although raising awareness is vitally important, the scope of World Hepatitis Day goes even further. The World Hepatitis Alliance has developed a wide-ranging integrated campaign, including initiatives focussed on driving policy change, both at an international and national level. The ‘12 Asks’ to governments are a central element of the campaign and set out key elements that should be incorporated into national strategies to ensure improvements in health outcomes for patients. All governments are being asked to sign up for the ‘12 Asks’. The World Hepatitis Alliance recognises that one day will not change the world. World Hepatitis Day is a stepping stone that focusses first on raising global awareness and then on securing international and national support for improvements in prevention, diagnosis, treatment, care and support for people living with chronic viral Hepatitis B.
Hepatitis B remains a significant public health problem in India and will continue to be so as long as commercial blood banks remain operational and until appropriate nationwide vaccination programmes and other control measures are established. Unfortunately, the shortfall between blood collected (1.5 million units per year) and blood needed (three million units per year) in India means that commercial blood banks will remain profitable unless the number of voluntary donors increases dramatically. Furthermore, programmes for the prevention and control of Hepatitis B should be a priority of the government and health services in India
To judge the impact and cost benefit ratio for Hepatitis B immunisation in India, analysis should be performed based on ‘true prevalence’ data. Further, in order to identify the correct strategy for such an immunisation programme, the relative importance of perinatal and horizontal transmission has to be defined for the population. If perinatal transmission is an important contributor to the carrier burden, then early immunisation schedule starting at the earliest after birth has to be implemented. Otherwise it may be acceptable to defer the first dose till one and a half months of age, which is more feasible, as one could merge it with existing schedule.
There is an urgent need for proper epidemiologic determination of the prevalence of HBV infection and associated morbidity/ mortality in India. This should be done taking into account the diversity in the country and the need for representation of all the sections of the population.
The World Hepatitis Day is completely a patient led campaign and also aims to secure political support for its activities to minimise new infections and improve health care for people already suffering from the infection. It aims to emphasise the need for “Increasing the protection for the silent infection”
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