Positivity for hepatitis virus is most common in age group 16 to 30 years: SRL study

Among major cities, the most prevalent hepatitis in Delhi, Mumbai, and Kolkata was Hepatitis E (39, 66 and 51 per cent respectively)

A total of 4719 consecutive,  anonymised samples were selected and analysed wherein tests for all four hepatitis viruses were done in one person in one go. There were 37 per cent percent of samples from female and 63 per cent from male. The most crucial screening and/or diagnostic tests for viral hepatitis viz. Hepatitis A IgM Antibodies, Hepatitis B Surface Antigen, Hepatitis C Antibodies, and Hepatitis E IgM Antibodies were considered in the analysis.

The results used in this retrospective study do not indicate any population numbers. Samples received for Hepatitis screening are suspected in a large number of cases. The report may be read keeping this fact in mind.

Summary of findings:

• Excluding the confounding factors like grey zones and indeterminate results, 1 in 5 samples suspected of hepatitis tested positive for either of the hepatitis virus (A, B, C or E)
• Positivity for hepatitis virus was most commonly seen in the age group 16 to 30 years
• More samples were received from males as compared to females who also showed a higher test positivity;  males (20 per cent) tested positive for viral hepatitis than females (15 per cent).
• Hepatitis E (21 per cent) was reported highest followed by Hepatitis A (18 per cent).
• Hepatitis A was the most common in children whereas Hepatitis E was most prevalent in adults.
• Males were found to be affected predominantly with Hepatitis E (46 per cent) while females were majorly affected by Hepatitis A (43 per cent).
• Among major cities, the most prevalent hepatitis in Delhi, Mumbai, and Kolkata was Hepatitis E (39, 66 and 51 per cent respectively).

Viral hepatitis is a cause of major health care burden in India and is equated as a threat comparable to the “big three” communicable diseases – HIV/AIDS, malaria and tuberculosis. Four common types of viral hepatitis i.e. A, B, C, and E have different modes of transmission, affecting different populations and resulting in different health outcomes. In India, available literature indicates that hepatitis A virus (HAV) and hepatitis E virus (HEV) are important causes of acute viral hepatitis and acute liver failure (ALF).

HAV is responsible for 10-30 per cent of acute hepatitis and 5-15 per cent of ALF cases in India. It is further reported that HEV accounts for 10-40 per cent of acute hepatitis and 15-45 per cent of ALF. Hepatitis B surface antigen (HBsAg) positivity in the general population ranges from 1.1 per cent to 12.2 per cent, with an average prevalence of 3-4 per cent. Anti-hepatitis C virus (HCV) antibody prevalence in the general population is estimated to be between 0.09-15 per cent. Around 40 million people are infected with hepatitis B and at least 6 to 12 million people with hepatitis C. About 176 000 people die each year of hepatitis B- and C-related complications – two times the estimated annual number of HIV and malaria deaths together (WHO 2019).

Although HAV and HEV which are both enterically (feco-oral route) transmitted are highly endemic in India, HEV has been responsible for most of these epidemics. Pregnant women and patients with chronic liver disease (CLD) constitute the high-risk groups to contract HEV infection and HEV-related death among them is substantial which underlines the need for preventive measures for such groups. HAV-related long-term liver damage is uncommon in India and occurs predominantly in children. Medical studies reveal that around 90% of the population acquires anti-HAV IgG antibodies and becomes immune to HAV by adolescence.

The frequency of HCV infection, as evaluated by anti-HCV antibody positivity, has been reported to be 1 per cent–2 per cent among voluntary blood donors and 0.87 per cent in the community; these figures are similar to those from developed countries such as Japan and the USA. About 15 per cent–30 per cent of acute hepatitis in India is due to HBV/HCV. However, HCV is an infrequent cause of acute hepatitis but causes most post-blood-transfusion hepatitis. HBV is the major cause of chronic hepatitis, cirrhosis and primary liver cell cancer in India.