HEPATITIS 

2. About Hepatitis

Hepatitis refers to the inflammation of the liver caused by various infectious viruses and non-infectious agents, potentially resulting in a range of health complications, some of which can be life-threatening.

• There are five primary strains of the hepatitis virus, categorized as types A, B, C, D, and E. While all types lead to liver disease, they differ significantly in terms of transmission modes, severity of illness, and geographical distribution.
• Hepatitis B and C are particularly notable as they can progress to chronic disease and are the leading causes of liver cirrhosis, liver cancer, and deaths related to viral hepatitis. An estimated 354 million individuals worldwide are living with hepatitis B or C, with many unable to access adequate treatment, as per the World Health Organization (WHO).

3. Key Findings of the Report

The report underscores the significant impact of viral hepatitis as the second leading infectious cause of death globally, with 1.3 million deaths annually, on par with tuberculosis, another top infectious killer.

• New data from 187 countries indicates a rise in estimated deaths from viral hepatitis from 1.1 million in 2019 to 1.3 million in 2022.
• Of these deaths, 83% were attributed to hepatitis B, while hepatitis C accounted for 17%. This highlights the predominance of hepatitis B as a major contributor to the global burden of viral hepatitis.
• The report reveals that 3,500 individuals succumb to hepatitis B and C infections each day worldwide, underscoring the urgency of addressing this public health challenge.
• Half of the burden of chronic hepatitis B and C infections is borne by individuals aged 30-54 years, with 12% affecting children under 18 years old. Moreover, men constitute 58% of all cases, indicating a gender disparity in hepatitis prevalence.

4. Vulnerability of India to Hepatitis

The report reveals several factors contributing to India's high hepatitis burden.

• India's densely populated environment facilitates the spread of infectious diseases like hepatitis B and C.
• Many people remain unaware of hepatitis symptoms and the importance of testing. This leads to undiagnosed cases that continue to transmit the virus unknowingly.
• Poor hygiene practices, particularly inadequate sanitation, can increase the risk of contracting hepatitis A and E, which spread through contaminated food and water.
• A significant issue is the high prevalence of chronic hepatitis B and C infections. These infections often go undetected for years due to a lack of symptoms, further perpetuating the transmission cycle.
• Lifestyle changes are contributing to an increase in non-viral forms of hepatitis. Increased alcohol consumption, especially in urban areas, is leading to more cases of alcoholic liver disease (ALD). Additionally, the growing prevalence of obesity, metabolic disorders, and sedentary lifestyles is fueling a non-alcoholic fatty liver disease (NAFLD) epidemic, which can progress to severe liver problems.
• Men are disproportionately affected due to higher rates of engaging in high-risk behaviours such as intravenous drug use, sharing needles, and unsafe sexual practices.

5. Prevention of Hepatitis

• Hepatitis B can be effectively prevented through vaccination. It is crucial to ensure widespread coverage of vaccination programs to protect against the transmission of the virus. Additionally, vaccination against hepatitis A and E may also be recommended in certain populations.
• Hepatitis C is curable with medications. In India, the cost of treatment is relatively low as the country produces generic versions of the drugs. Access to affordable treatment options is essential to reduce the burden of hepatitis-related deaths.
• India has implemented the viral hepatitis control program, which offers vaccines to high-risk adults, including healthcare workers. Treatment for both hepatitis B and C is available under this program.
• The Indian Government has integrated the hepatitis B vaccine into the childhood immunization program since 2011-12. This ensures that children are protected against chronic hepatitis B infection from an early age, reducing the risk of transmission in the population.
• Raising awareness about hepatitis prevention, transmission routes, and the importance of vaccination and treatment is crucial. Educational campaigns targeting both the general population and high-risk groups can help reduce the incidence of hepatitis and its associated complications.

6. Significance of the Report

The significance of the report lies in several key aspects

• It marks the first consolidated report by the World Health Organization (WHO) on viral hepatitis epidemiology, service coverage, and product access. The report provides a comprehensive overview of the disease burden and coverage of essential viral hepatitis services across 187 countries.
• The report presents the latest estimates on the disease burden of viral hepatitis, shedding light on the prevalence and impact of the disease worldwide. This information is crucial for policymakers, healthcare professionals, and stakeholders to formulate effective strategies for prevention and control.
• It evaluates the coverage of essential viral hepatitis services, including diagnosis and treatment, highlighting gaps and areas for improvement in healthcare delivery systems globally.
• The report compares the current diagnosis and treatment coverage with global targets set to treat 80% of people living with chronic hepatitis B and hepatitis C by 2030. The findings indicate that current levels of diagnosis and treatment fall well below these targets, emphasizing the need for accelerated efforts to meet these goals.
• While the report shows slight improvements in diagnosis and treatment coverage since 2019, it also highlights persistent challenges and disparities in access to healthcare services for viral hepatitis. This information can guide policymakers and stakeholders in implementing targeted interventions to address these challenges effectively.

7. The Way Forward

• Efforts should focus on eliminating mother-to-child transmission and ensuring extensive treatment coverage, including immunization of every newborn. Discrimination against patients must be eradicated to create a supportive environment for prevention and treatment initiatives.
• Countries must prioritize procurement of affordable generic viral hepatitis medicines to ensure access for all. Pricing disparities need to be addressed, both across and within WHO regions, to ensure equitable access to essential medications.
• Service delivery for viral hepatitis should be decentralized and integrated into primary healthcare systems. This shift from centralized and vertical approaches will reduce out-of-pocket expenses for affected populations and improve access to essential services.
• A public health approach to viral hepatitis should prioritize expanding access to testing and diagnostics, implementing policies for equitable treatment, and strengthening prevention efforts. This approach requires improved funding at both global and national levels, including allocations within countries' health budgets.
• Efforts must be intensified to achieve the global targets for viral hepatitis elimination by 2030. This requires sustained commitment from governments, international organizations, civil society, and other stakeholders to implement evidence-based interventions effectively.

By implementing these actions, countries can accelerate progress towards ending the viral hepatitis epidemic by 2030, improving health outcomes and reducing the burden of this preventable disease worldwide.