World Hepatitis Day: Getting rid of disease remains a challenge

New Delhi: Despite the cost of drugs coming down and dramatic advances in the treatment of Hepatitis B and Hepatitis C, getting rid of both types of the disease remains a huge challenge primarily due to lack of awareness and unsafe injection practices, experts have rued.

Hepatitis B is 50-100 times more infectious than HIV and Hepatitis C is 10 times more infectious than the virus that can cause AIDS. Yet, while people are by and large aware of HIV, there is little awareness about Hepatitis, health experts have lamented.

"In India, Hepatitis is a matter of concern because three to six billion injections are given each year, of which two-thirds are unsafely administered. This makes a large part of the population vulnerable to viruses transmitted through the blood," Siddharth Srivastava, Associate Professor, GB Pant Hospital here told IANS.

Hepatitis B and C are silent killers. They live in the body for decades, without showing any symptoms. When symptoms finally appear, they signal that the liver itself has been affected, making treatment difficult.

About one million Indians are at risk of acquiring Hepatitis B infection and about 10,000 die from the virus every year. This number is huge especially considering the fact that it is a vaccine-preventable disease, Srivastava said.

"A complete evaluation needs to be done after Hepatitis is detected which would tell us the extent of liver damage and level of viral replication. This would mean a number of tests like viral load (PCR), ultrasound, Fibro scan, and at time endoscopy need to be performed," said Yogesh Batra, Director, Gastroenterology and Hepatology, BLK Super Speciality Hospital in New Delhi.

There are five types of Hepatitis named A, B, C, D and E. Hepatitis A and E are water borne and spreads through contaminated water or food, often produce more dramatic symptoms such as jaundice, but last for short durations.

Hepatitis B, C and D are blood borne. Hepatitis D causes infection only along with Hepatitis B.

The concern is usually for Hepatitis B which can spread unknowingly from an infected mother to a newborn.

"Testing for Hepatitis B (HBsAg) is now mandatory during pregnancy. If a mother tests positive, infection to the coming newborn can be prevented by immediate vaccination (active and passive) to the newborn within 12 hours. Some mothers may also require treatment with oral medications during pregnancy to reduce the viral load and hence risk of passing the infection down," Gourdas Choudhuri, Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital, Gurgaon, said.

The irony is that Hepatitis B has a vaccine, but no cure, while Hepatitis C has no vaccine, but does have a cure.

"Hepatitis B vaccine is a safe, affordable, well tested vaccine which is now included in the infant imminisation programme. Unfortunately, a large number of citizen who are five years or older had not received the vaccine when they were kids. There is a need for everyone to get vaccinated against Hepatitis B as it gives a life time protection from this killer viral infection," Choudhuri suggested.

Hepatitis C is also fairly common, with around one per cent of the population harbouring the virus without knowing it. Blood test is the only way to detect it.

The treatment for Hepatitis C is now simple and affordable with oral tablets clearing the infection in three to six months.

The cost of treatment for Hepatitis B is approximately Rs 700 to 2000 per month while that for Hepatitis C is around Rs 14,000 per month, Choudhuri pointed out.

"With modern oral medicines for Hepatitis C (sofosbuvir, ledipasvir and daclatasvir), complete cure of this infection is now possible in over 90 per cent of patients. In fact India is the best place in the world today for treating Hepatitis C as these new medications are available here at one per cent of the international price," Choudhuri maintained.

However, the experts suggested that there is an immediate need to put a check on the unsafe injection administration.

"Patients too need to be vigilant and know of the safe injection practices, like the use of sterile, single-use, reuse prevention syringes. Staff should wash their hands before administering the injection, and they should clean the area of the injection adequately. They should definitely not be touching the injection with their hands," Srivastava noted.