A primer on Hepatitis A, B and C: This World Hepatitis Day, let’s pledge to de-stigmatize and end the life threatening disease
“I know I will never be Hepatitis B negative and my partner will never accept me. It is better to die than live this life of daily neglect and humiliation”. Such are the woeful tales of millions of hepatitis B-infected men and women in India. Today, the transmission of hepatitis B mainly occurs from infected mothers to their babies and those who get the virus can never escape it as things coming from the mother are considered to be good by the child’s body.
There are five common viruses affecting the liver, named using alphabets A to E. Both hepatitis A (commonly in children) and E (often in adults) are transmitted by consuming infected food and water. Acute infections are most often visible in the form of loss of appetite, fever and jaundice, and are self limiting. Hepatitis B and C — transmitted by blood and body secretions — such as infected blood, needles (tattoos, ear pricks, injections, etc.), razors and unprotected sex — cannot be cleared easily by the body’s immune system and often become chronic.
These viruses remain hidden in the body, multiply in the liver and slowly kill the liver cells which get replaced by scar tissue. If not treated, in a proportion of subjects, they cause cirrhosis (small, shrunken liver, can lead to swelling in body, jaundice and coma) and even liver cancer. Asia contributed to about 55% of global deaths due to cirrhosis and 73% of deaths due to liver cancer; hepatitis B accounted for nearly half of the latter in the year 2015. India hosts about 40 million hepatitis B infected subjects. Hepatitis C affects another 10 million of Indians. Hepatitis B can be prevented. Three shots of vaccine to adults (zero day, one month and sixth month), four to every newborn (birth, sixth, tenth and 14th weeks) provide life-long immunity against hepatitis B.
Those infected with hepatitis B often need antiviral drugs, which can effectively suppress the virus for life. If we treat all those infected (considering an average lifespan of 70 years) and vaccinate all the newborns today, India will be free of hepatitis B by 2080. Let us charter and march towards Mission 2080. However, there is no vaccine for hepatitis C and the only prevention is by not using infected blood and needles. Fortunately, the treatment of hepatitis C has become very easy and affordable (a 12-week course, costs less than 4,000 INR and is effective in 95% of patients).
Diagnosis and drugs for both hepatitis B and C are readily available and, under National Viral hepatitis Control Program, are free for everyone. India is facing three main challenges in the elimination of these deadly viruses: First, to find those who are infected. The high-risk groups for hepatitis B include infected mothers and all family members, and for both hepatitis B and C, subjects receiving blood transfusions, injections, and infected with HIV. Hepatitis C should be suspected in all those who have undergone major surgery or blood transfusion before 2001, the year before which blood in blood banks was not tested for hepatitis C in India.
Only awareness and people’s movements can help detect the infected in India, the missing millions. The second challenge is that of one-stop testing and treatment during a visit to a health facility. Both hepatitis B and C viruses require initial estimation of the quantity of the virus in the blood. Currently, facilities for these tests are available only in large setups and it takes days to get results. We need pointof-care tests, which can give results between one and two hours, so that the infected can be administered drugs on the same visit. The world is moving in this direction and the Institute of Liver and Biliary Sciences (ILBS) and FIND (a voluntary organisation) have been able to develop a Delhi Model for diagnosis and treatment for hepatitis C in this direction.
The third major challenge is social isolation. The stigma attached to hepatitis B and C is far reaching and one needs to live the life of the infected, to understand the challenges faced by them. Often, the discovery of the disease or the beginning of the treatment can lead to significant changes in the lives of the patients and their families. Social rejection (by family, friends, colleagues and neighbours), economic stigma (difficulty in securing jobs and job losses), embarrassment (fear of disclosure), and lack of self-confidence are experienced daily by every subject suffering from hepatitis B and C. It is the society’s responsibility to understand the sufferers, give them an equal opportunity to live, study, earn, and grow with dignity.
Let us take a pledge this World Hepatitis Day, to join hands and overcome all the three challenges so as to eliminate hepatitis B and C from India at the earliest.
(Courtesy of Mail Today)
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